AMERICAN  RED  CROSS 
ABRIDGED 

FIRST  AID  TEXT-BOOK 

WOMAN'S  EDITION 


LYNCH 


AMERICAN   RED   CROSS   ABRIDGED   TEXT-BOOK 

ON 

FIRST    AID 


WOMAN'S  EDITION 


A  MANUAL  OF  INSTRUCTION 


BY 

MAJOR  CHARLES  LYNCH 

MEDICAL  CORPS,   UNITED  STATES  ARMY 


Prepared  and  Endorsed  by  the  American  Red  Cross 


WITH  ILLUSTRATIONS 


PHILADELPHIA 
P.   BLAKISTON'S   SON   &   CO 

1012   WALNUT   STREET 


Copyright,  191 3,  by  P.  Blakiston's  Son  &  Co. 

Reprinted,  November,  1914 

Reprinted,  January,  1915 

Reprinted,  April,  191 5 

Reprinted,  November,  1915 

Reprinted,  January,  191 6 

Reprinted,  March  6,  1916 

Reprinted,  March  25,  1916 

Reprinted,  April,  1916 

Reprinted,  June,  1916 

Reprinted,  July,  1916 

Reprinted,  January,  1917 

Reprinted,  February,  1917 

Reprinted,  March  2,  191 7 

Reprinted!  March  12,  J9X9 


E    MAPLE    PKEf 


Y  OKK    PA 


PREFACE 


WOMAN'S  EDITION 


The  experience  of  the  American  Red  Cross  in  teaching  first 
aid  to  the  injured  since  its  first  manual  on  this  subject  was  pub- 
lished in  1908  has  shown  that  it  would  be  highly  desirable  to 
have  a  special  edition  for  women.  The  present  edition  has, 
therefore,  been  prepared  to  meet  their  needs. 

It  should  be  explained  further  that  the  experience  of  the  First 
Aid  Department  of  the  American  Red  Cross  has  been  that 
certain  knowledge  of  first  aid  is  necessary  to  every  student  of 
the  subject,  and  the  plan  adopted  for  its  various  manuals  has 
been  to  publish  the  information  essential  to  all  in  chapters  which 
correspond  in  each  edition.  In  other  chapters  is  found  the  special 
information  which  is  only  of  value  to  the  special  class  for  which 
the  edition  was  prepared. 

Notwithstanding  the  lack  of  an  instruction  book  wholly 
adapted  to  their  needs,  many  hundred  women  have  already  re- 
ceived first-aid  instruction  under  Red  Cross  auspices  and  with 
the  very  best  results.  A  mass  of  testimony  to  this  effect  has 
been  voluntarily  offered  from  many  different  sources.  It  is 
hoped  that  the  present  manual  will,  as  far  as  may  be,  result 
not  only  in  many  more  women  studying  first  aid  to  the  injured 
but  also  in  giving  women  students  of  the  subject  better  practi- 
cal knowledge  than  has  hitherto  been  available  to  them  in  a  book. 

Of  course,  it  is  realized  that  a  good  teacher  is  more  valuable 
than  any  book  can  ever  be.  All  that  a  book  on  first  aid  can  do 
is  to  gather  together  the  information  which  has  proved  most 
valuable  in  the  experience  of  teachers  and  in  actual  practice. 

It  is  desired  to  take  advantage  of  this  occasion  to  express  the 

v 


VI  PREFACE 

thanks  of  the  author  to  the  many  physicians  throughout  the 
country  whose  advice  and  assistance  are  embodied  in  this  little 
manual.  The  thanks  of  the  American  Red  Cross  are  also  due 
to  the  many  physicians  who  have  served  as  first-aid  instructors, 
to  the  organizers  of  classes  and  to  others  Who  have  assisted  in 
various  ways  in  the  dissemination  of  knowledge  of  first  aid  to  the 
injured. 


CONTENTS 

CHAPTER  I 

Page 

What  First  Aid  to  the  Injured  is;  General  Directions 

for  Giving  First  Aid;  Shock i 

CHAPTER  II 
Bandages 10 

CHAPTER  III 

Injuries  in  Which  the  Skin  IS  NOT  Pierced  or  Broken 

Bruises;  Strains;  Sprains;  Dislocations;  Fractures 22 

CHAPTER  IV 

[n juries  in   Which  the  Skin  IS  Pierced  or  Broken; 

Wounds 47 

CHAPTER  V 
Bleeding 65 

CHAPTER  VI 

Injuries  Due  to  Heat  and  Cold 

Burns  and  Scalds;  Sunstroke  and  Heat  Exhaustion;  Frost- 
bite and  Freezing 82 

CHAPTER  VII 

Suffocation    and    Artificial    Respiration;   Drowning; 

Electric  Shock;  Gas  Poisoning;  Hanging 91 

vii 


Viii  CONTENTS 

CHAPTER  VIII 

Page 
Unconsciousness  or  Insensibility.     Poisoning 107 

CHAPTER  IX 

Common  Emergencies 

1.  Cramp  or  Colic.  2.  Diarrhea.  3.  Constipation.  4. 
Nausea  and  Vomiting.  5.  Hiccough.  6.  Chill  from 
Exposure.  7.  Nervous  Attack.  8.  Croup.  9.  Neuralgia 
of  Face.  10.  Tooth-ache.  11.  Ear-ache.  12.  Styes.  13. 
Sunburn.  14.  Prickly  Heat.  15.  Poison  Ivy  or  Oak. 
16.  Mosquito  Bites.  17.  Chilblains.  18.  Corns.  19. 
Poisonous  Plants,  especially  Mushrooms.  20.  Home 
Medicines JI7 

CHAPTER  X 

Carrying  and  Home  Preparations  for  Sick  and  Injured 

1.  Carrying.  2.  Lifting  into  Bed.  3.  Selection  and  Prep- 
aration of  Room.  4.  Selection  and  Preparation  of  Bed. 
5.  Removal  of  Clothing.  6.  Position  in  Bed.  7.  Prep- 
arations for  Doctor    4 •  132 

Index J45 


AMERICAN  RED  CROSS  ABRIDGED 
TEXT-BOOK  ON  FIRST  AID 

WOMAN'S  EDITION 


CHAPTER  I 


WHAT  FIRST  AID  TO  THE  INJURED  IS;    GENERAL 
DIRECTIONS  FOR  GIVING  FIRST  AID;  SHOCK 

What  First  Aid  to  the  Injured  Is 

We  all  know,  of  course,  that  a  doctor  as  he  has  given  years 
to  studying  the  subject  is  best  qualified  to  take  care  of  ill  and 
injured.  On  the  other  hand,  accidents  and  sudden  illness  often 
occur  where  the  services  of  physicians  cannot  be  immediately 
obtained.  The  necessary  delay  may  result  very  disastrously 
for  the  ill  or  injured.  A  very  large  experience  has  shown  that 
any  intelligent  person  can  learn  what  to  do  in  such  emergencies. 
First  aid^to  the  injured  must  be  learned,  however,  like  every 
other  subject  and  no  one  will  know  what  to  do  for  ill  or  injured 
unless  he  has  studied  it.  But  all  that  is  necessary  for  good  re- 
sults is  that  the  student  have  common  sense  and  devote  the 
small  amount  of  time  required  for  acquiring  the  special  knowl- 
edge and  skill. 

Knowledge  of  first  aid  to  the  injured  is  a  very  valuable  and  very 
cheap  form  of  insurance.  Possibly  we  may  never  need  this 
knowledge,  but  the  wise  man  or  woman  would  hardly  be  willing 
to  let  any  building  go  without  insurance  on  the  chance  that  it 
would  never  burn.     How  much  more  important  it  is  for  us  to 


2  WHAT  FIRST  AID   TO   THE  INJURED   IS 

insure  our  own  selves  against  the  bad  results  of  accidents  through 
knowledge  of  first  aid  to  the  injured. 

There  is  no  clashing  of  interest  between  the  doctor  and  the 
first  aider.  The  duties  of  the  former  begin  when  the  latter 
leave  off.  Knowledge  of  first  aid  enables  trained  persons  to 
put  patients  into  doctors'  hands  in  the  best  possible  condition 
for  cure.  It  should  also  enable  them  to  recognize  the  severity 
of  an  injury  or  illness  so  that  when  necessary  they  may  call  a 
doctor  promptly.  Treatment,  except  of  very  minor  cases  of  in- 
jury or  illness  and  the  care  of  injured  and  ill  in  an  emergency 
till  a  doctor  can  be  procured  is  not  first  aid.  Such  treatment  can- 
not be  learned  from  this  book,  and  cannot  be  too  strongly 
condemned. 

Accidents  have  become  far  too  common  and  the  attention  of 
every  student  of  first  aid  is  earnestly  invited  to  the  great  bene- 
fits to  be  gained  by  studying  how  to  prevent  them  as  part  of  his 
or  her  course  in  first  aid.  Prevention  is  better  than  cure  in  in- 
jury as  well  as  in  disease  and  is  just  as  practical.  In  both,  good 
results  in  this  respect  are  mainly  dependent  on  the  action  of  in- 
dividuals. Every  injury  described  in  this  book  should  suggest 
how  the  accident  which  caused  it  might  have  been  prevented. 
Still  more  if  any  first  aider  cares  for  a  real  injury  he  or  she  should 
think  over  the  cause  for  it  carefully  and  so  far  as  within  their 
power  take  steps  to  prevent  a  similar  accident  in  the  future. 

General  Directions  for  Giving  First  Aid 

If  no  doctor  is  present  when  an  accident  occurs  someone  must 
take  charge  of  things.  This  duty  naturally  falls  on  the  first 
aider.  This  is  what  he  has  studied  first  aid  for  and  he  should 
always  stand  ready  to  take  the  responsibility.  In  justice  to 
the  injured  person  and  to  himself  he  must  not  allow  interference 
by  other  people.  The  only  people  who  should  be  near  an  in- 
jured person  are  those  required  to  help  him.  He  needs  all  the 
air  he  can  get  and  a  crowd  about  him  will  use  air  that  he  should 
have. 

Be  observant.     Everything  depends  upon  this.     See  every- 


DIRECTIONS   FOR   GIVING   FIRST  AID  3 

thing  and  think  what  each  thing  means.  Then  you  can  hardly 
go  wrong  in  caring  for  the  patient. 

Be  calm  and  don't  be  hurried.    Be  quiet  and  cool. 

If  a  doctor  is  within  immediate  call  it  may  hardly  be  necessary  for 
the  first  aider  to  do  more  than  to  send  for  the  doctor  and  to 
keep  the  crowd  away  from  the  injured  person.  The  action  taken 
depends  on  the  injury,  however;  for  example,  it  would  be  very 
foolish  to  wait  a  moment  for  a  doctor  if  there  were  danger  of 
death  from  bleeding  or  in  any  accident  where  delay  would  be 
dangerous.  On  the  other  hand,  often  it  may  be  better  to  have 
a  doctor  care  for  the  injury  from  the  first.  In  giving  first  aid 
it  is  quite  as  necessary  to  know  what  npt  to  do  as  what  to  do.  In 
any  case  if  the  services  of  a  doctor  can  be  had  it  is  always  best 
to  employ  them,  except  for  slight  injuries.  Moreover,  if  any 
doubt  exists  in  regard  to  this,  it  is  best  to  send  for  a  physician 
or  to  take  the  injured  person  to  a  doctor  as  soon  as  possible. 
It  should  be  remembered  that  injuries  which  are  apparently 
trivial  may  sometimes,  if  not  treated  promptly  by  a  doctor, 
have  serious  consequences,  and  that  a  physician  called  in  time 
may  prevent  conditions  which  when  fully  established  are  beyond 
the  help  of  medical  science. 

Tight  clothing  interferes  with  both  breathing  and  circulation. 
The  collar  should  be  loosened  at  once,  and  also  usually  the  belt, 
likewise  anything  else  around  the  body  which  is  tight. 

Generally  speaking,  if  something  special  does  not  need  imme- 
diate attention,  the  next  thing  to  do  is  to  get  the  injured  person 
into  a  safe  and  comfortable  position.  The  best  position,  unless 
there  is  some  reason  to  the  contrary,  is  on  the  back  with  the  head 
low.  With  a  flushed  face,  the  head  may  be  raised  on  a  small 
pillow  or  folded  coat;  with  a  pale  face,  it  should  not  be  raised  at 
all.  If  a  person  is  vomiting,  he  should  be  placed  on  his  side  or 
his  head  should  be  turned  to  one  side,  so  that  the  matter  vomited 
will  not  go  into  his  windpipe  and  choke  him.  Unconscious 
persons  cannot  swallow  and  so  they  should  never  be  given  water, 
stimulants,  etc.,  as  these  will  choke  them  by  entering  the  wind- 
pipe. Slight  cases  of  illness  and  injury  may  sit  up,  but  one  must 
be  sure  that  all  seriously  injured  are  kept  lying  down. 


4  WHAT  FIRST  AID   TO  THE   INJURED   IS 

Do  not  be  hurried  into  moving  a  person  from  the  place  where 
his  accident  has  occurred  and  always  make  sure  first  that  he  is 
not  going  to  be  injured  further  by  being  moved.  It  is  specially 
dangerous  to  move  persons  with  broken  bones  before  proper 
treatment  has  been  given  as  the  ends  of  the  broken  bones  are 
very  sharp  and  cut  like  a  knife. 

A  hurt  person  will  frequently  ask  for  water,  which  may  be 
given  with  perfect  safety.  Cold  water  is  usually  more  refreshing, 
but  whether  cold  or  hot,  it  must  be  given  fairly  slowly  so  that  the 
injured  person  has  time  to  swallow  between  sips.  To  neglect 
giving  a  stimulant  when  it  is  required  would  be  a  grave  error  of 
judgment.  The  first  thought  with  many  people,  however,  is 
to  procure  whisky  or  brandy  for  every  sufferer  from  illness  or 
injury.  These  are  really  as  unnecessary  for  every  case  as  would 
be  the  application  of  splints  to  the  leg  of  every  injured  man. 
They  should  never  be  given  in  injuries  of  the  head,  and  it  should 
be  remembered  that  while  a  small  quantity  of  liquor  acts  as  a 
stimulant,  large  ones  are  depressing.  If  you  have  it,  always 
use  aromatic  spirits  of  ammonia  as  a  stimulant  in  preference  to 
any  alcoholic  liquor. 

Whatever  the  injury  may  be,  it  must  be  seen  clearly  before  any 
attempt  is  made  to  treat  it.  In  order  to  do  this  it  will  generally 
be  necessary  to  remove  some  of  the  clothing.  This  is  likely  to  be 
very  painful  and  possibly  dangerous  for  the  injured  person, 
unless  he  is  handled  with  the  greatest  gentleness.  In  removing 
clothing,  rip  up  the  nearest  seam  in  the  outer  clothing  and  cut  or 
tear  the  underclothing.  The  sound  side  should  be  undressed  first 
so  that  the  injured  side  will  be  subjected  to  less  movement.  In 
injuries  to  the  foot  and  ankle  it  will  rarely  be  possible  to  remove 
the  boots  or  shoes  without  giving  severe  pain  and  perhaps  doing 
considerable  damage,  so  they  should  be  cut  freely  when  this  is 
necessary. 

The  first  aider  must  make  use  of  what  he  finds  on  the  spot. 
He  must  explain  clearly  to  any  helpers  just  what  he  wants  them 
to  do. 

When  there  are  several  injuries  the  most  severe  should  be  cared 
for  first. 


SHOCK  5 

Shock 

More  or  less  shock  is  caused  by  all  injuries  and  it  must  be 
thought  of,  and  treated  when  necessary. 

Description. — Shock  is  a  more  or  less  profound  depression  of 
the  nervous  system.  It  is  sometimes  called  collapse  or 
prostration. 

For  the  convenience  of  the  student  the  human  body  is  divided 
into  various  systems.  One  of  these  and  perhaps  the  most  im- 
portant as  it  regulates  the  action  of  all  the  others  is  the  nervous 
system.  This  is  a  very  delicate  system  which  is  easily  disturbed. 
Everybody  knows  what  a  mental  shock  is.  A  person  receives 
bad  news,  for  example,  he  grows  pale,  perhaps  is  unable  to 
move,  or  even  becomes  half  conscious  or  totally  unconscious  and 
may  die.  We  say  he  has  received  a  shock.  This  is  exactly 
what  happens  as  the  result  of  an  injury.  That  is  to  say,  shock 
always,  whatever  the  cause,  is  as  stated,  a  more  or  less  severe 
depression  of  the  nervous  system. 

Causes. — Usually  a  severe  injury.  Some  persons  are  sensitive 
to  shock,  however,  and  so  with  them  more  shock  will  follow  a 
slight  injury  than  is  the  case  with  a  severe  injury  in  less  sensi- 
tive persons. 

Prevention. — The  prevention  of  accidents,  especially  severe 
accidents.  Also  do  not  allow  an  injured  person  to  see  his  own 
injury,  as  this  is  apt  to  increase  shock.  This  is  especially  true 
with  severe  bleeding. 

Symptoms. — (This  is  a  word  whose  meaning  should  be  known 
to  every  first  aider.  Symptoms  are  everything  that  an  injured 
or  ill  person  shows  or  feels  because  of  an  injury  or  disease.) 
Usually  appear  as  soon  as  an  injury  is  received.  Face  is  pale 
with  an  anxious  expression;  eyelids  droop;  eyes  are  dull  and  the 
pupils  are  large.  (The  pupils  are  the  black  circles  in  the  center 
of  the  eye.)  Skin  is  cold  and  covered  with  a  cold  sweat.  The 
injured  person  is  more  or  less  stupid  and  takes  no  interest  in  any- 
thing happening  near  him.  May  be  partly  or  totally  uncon- 
scious or  mind  may  wander.  Usually  he  lies  perfectly  quiet 
and  will  not  move  unless  disturbed.     Breathing  is  feeble  and 


6  WHAT   FIRST  AID  TO  THE  INJURED   IS 

shallow.  Pulse  is  rapid  and  weak.  May  not  be  able  to  feel 
it  at  the  wrist.  (The  first  aider  should  be  able  to  count  the  pulse 
at  the  wrist.  Seventy-two  per  minute  is  the  usual  rate  in  per- 
fect health  but  this  varies  considerably.  Exercise,  for  example, 
increases  the  rate  perhaps  many  beats  per  minute.) 

Usually  shock  is  recovered  from,  the  improvement  being 
gradual  but  the  shock  may  grow  worse  and  death  finally 
occur. 

It  might  be  thought  any  one  should  easily  know  when  a  person 
is  suffering  from  shock.  This  is  the  case  usually  but  not  invari- 
ably. If  you  see  the  accident  and  its  effect  you  can  hardly  make 
a  mistake  but  suppose  you  do  not  see  the  accident  then  you  may 
have  nothing  to  judge  by  except  the  symptoms  just  given. 

Treatment. — Send  for  doctor  at  once  if  possible.  Warm  and 
stimulate  in  every  possible  way  before  arrival  of  doctor. 

First,  place  injured  person  on  back  with  head  low  so  that  plenty 
of  blood  will  enter  brain. 

Stimulants  should  always  be  given  if  he  is  able  to  swallow. 
Hot  coffee,  hot  tea  or  half  a  teaspoonful  of  aromatic  spirits  of 
ammonia  in  a  half  glass  of  water.  Whisky  may  be  only  stimu- 
lant procurable.  If  used,  give  one  large  drink  only,  as  more  is 
likely  to  cause  depression.  Ammonia  or  smelling  salts  to  nose, 
help,  when  procurable. 

Never  remove  more  clothing  than  necessary  from  an  injured 
person  as  this  will  cause  more  severe  shock,  and  when  possible 
spread  coats  or  blankets  over  him. 

Place  hot- water  bottles  or  hot  bricks  around  him  when  possible; 
flannels  wrung  out  in  hot  water  applied  to  abdomen  and  chest 
have  the  same  effect.  Rubbing  legs  and  arms  toward  body, 
under  blankets,  quickens  circulation  of  the  blood  and  is  useful. 
Be  careful  while  doing  this  not  to  uncover  the  injured  person. 

Warning. — While  shock  is  so  extremely  common  in  injuries 
that  it  should  always  be  kept  in  mind  and  treated,  it  must  not 
be  forgotten  that  something  more  dangerous  even  than  shock 
may  require  attention.  The  symptoms  of  severe  bleeding  are 
very  like  shock,  and  if  shock  only  is  treated  in  such  a  case  and 
the  bleeding  is  not  stopped  the  patient  may  bleed  to  death. 


STIMULANTS  7 

More  about  Stimulants. — Most  first-aid  stimulants  have  al- 
ready been  mentioned  but  it  will  perhaps  be  well  to  say  a  few 
words  more  respecting  their  use. 

All  stimulants  taken  internally  are  best  given  hot  when  possible 
as  aside  from  the  particular  stimulant  used,  heat  itself  is  a  power- 
ful stimulant  whether  employed  internally  or  externally.  Safe 
and  easily  procurable  stimulants  are  tea  and  coffee,  a  glass  of 
wine,  a  dessertspoonful  of  whisky  or  brandy  with  an  equal  quan- 
tity of  water,  or  a  teaspoonful  of  pure  alcohol  with  three  times 
the  quantity  of  water  (not  wood  alcohol  or  denatured  alcohol, 
which  are  poisons). 

Alcohol  in  some  form  may  usually  be  easily  procured  and  this 
use  of  alcohol  is,  of  course,  purely  a  medicinal  one  which  has  noth- 
ing to  do  with  the  question  of  the  drinking  of  alcoholic  liquors. 
But  many  people  object  to  the  use  of  alcohol  under  any  cir- 
cumstances. In  large  amounts  it  is  depressing  and  not  stimu- 
lating, and  for  other  reasons  it  is  never  advisable  to  carry  whisky 
or  brandy  for  first-aid  purposes.  Aromatic  spirits  of  ammonia 
which  has  none  of  the  disadvantages  of  alcohol  is  the  best  first- 
aid  stimulant.  It  is  best  given  in  half-teaspoonful  doses  in 
one-half  a  glass  of  hot  water. 

As  unconscious  persons  cannot  swallow,  for  them  we  must 
make  use  of  a  stimulant  which  may  be  inhaled.  The  best 
stimulant  under  these  circumstances  is  water  of  ammonia, 
hartshorn,  or  smelling  salts.  This,  of  course,  is  held  under  the 
nose  so  its  fumes  may  be  breathed  in. 

Heat  employed  externally  is  such  a  very  valuable  stimulant 
that  every  first-aid  student  should  know  how  to  make  use  of  it. 
The  ordinary  hot- water  bag  is  most  convenient  for  this  purpose, 
but  glass  bottles  and  jars  are  good.  They  should  be  covered 
with  cloth  or  paper  to  prevent  them  from  burning  the  patient. 
Hot  bricks  and  stones  are  also  useful.  In  using  heat  in  this  way 
it  must  be  remembered  that,  especially  with  an  unconscious 
person,  there  is  considerable  danger  of  causing  severe  burns,  so 
one  must  make  sure  by  testing  the  bottle,  etc.,  on  his  arm  or 
face,  that  it  will  not  burn  even  if  left  in  contact  with  the  skin  for 
some  time.    In  applying  heat  by  means  of  the  objects  mentioned, 


8  WHAT  FIRST  AID   TO  THE  INJURED   IS 

to  get  the  greatest  effect,  they  should  be  placed  between  the 
legs,  at  their  outer  sides  and  between  the  body  and  the  arms.  A 
light  hot- water  bag  lying  over  the  heart  acts  as  a  special  stimulant 
to  it. 

Rubbing  not  only  quickens  the  circulation,  but  is  also  stimu- 
lating. 

As  has  been  indicated  in  discussing  shock,  all  the  different 
classes  of  stimulants  are  best  used  together  when  they  can  be 
obtained. 


QUESTIONS 

i.  What  is  First  Aid  to  the  Injured? 

2.  Suppose  you  have  to  care  for  an  injured  person.     What  would 
you  do  first. 

3.  When  should  you  send  for  a  doctor,  or  take  the  injured  person 
to  a  doctor? 

4.  What  about  tight  clothing? 

5.  When  would  you  move  an  injured  person? 

6.  What  are  the  dangers  of  moving  an  injured  person? 

7.  What  do  you  know  about  giving  injured  persons  water;  stimu- 
lants? 

8.  Should  clothing  always  be  removed? 

9.  When  would  you  remove  some  of  the  clothing  and  how  would 
you  do  this? 

10.  When  does  shock  occur? 

11.  What  is  shock?  Cause  of  shock?  Prevention?  Symptoms? 
Treatment?     What  is  a  symptom? 

12.  Suppose  you  see  a  person  whom  you  think  is  severely  shocked, 
what  would  you  look  for  in  order  to  determine  nothing  more  severe  than 
shock  had  occurred? 

13.  Explain  the  use  and  abuse  of  stimulants. 


PRACTICAL  EXERCISES 

Have  one  of  the  class  pretend  to  be  injured,  or  secure  some  one  else 
to  act  as  "subject."  Members  of  the  class  should  be  required  to  show 
just  what  they  would  do  for  any  case  of  injury.  They  should  also 
be  required  to  loosen  and  to  remove  clothing,  the  place  of  the  injury 


PRACTICAL   EXERCISES 


having  been   stated.     They  should  place   the  injured  person  in  the 
proper  position.     The  pupil  of  the  eye  should  be  demonstrated  and 
each  member  of  the  class  should  be  required  to  take  the  pulse. 
Show  on  the  subject  exactly  what  should  be  done  in  shock. 


CHAPTER  II 

BANDAGES 

The  first  aider  must  learn  to  use  his  hands  as  well  as  his  head. 
To  know  how  to  bandage  well  is  necessary  for  him.  Practice 
makes  perfect  in  this  as  well  as  in  other  respects  and  the  first- 
aid  student  should  learn  how  to  bandage  as  early  as  practical  in 
his  course  of  instruction  and  thereafter  take  every  opportunity 
to  perfect  himself  by  constant  practice. 

Kinds  of  Bandages 

i.  The  Triangular  Bandage. 

2.  The  Roller  Bandage. 

3.  The  Four-tailed  Bandage. 

1.  Triangular  Bandage. — The  triangular  bandage  is  perhaps 
best  suited  for  general  first-aid  work,  as  it  can  be  easily  made,  is 
not  difficult  to  apply  as  a  temporary  dressing  and  is  not  likely  to 
be  put  on  so  tightly  that  it  will  cause  injury  by  stopping  the 
circulation  of  the  blood. 

Some  first-aid  classes  may  desire  to  learn  the  use  of  this  band- 
age alone.  If  so  the  description  of  the  other  kinds  of  bandages 
and  their  use  may  be  omitted.  For  the  reasons  stated  later, 
however,  it  is  believed,  generally  speaking,  skill  in  the  applica- 
tion of  the  other  bandages  is  desirable  for  the  first  aider. 

The  triangular  bandage  is  commonly  made  from  unbleached 
cotton  cloth,  though  any  strong  cloth  will  answer.  Bed  sheets, 
pillow  cases,  napkins  and  handkerchiefs  may  all  be  used  to 
make  it. 

It  is  desirable  that  the  piece  of  cloth  for  the  bandage  be  not 
less  than  34  to  38  inches  square.  It  is  folded  diagonally  and  is 
cut    across  in  the  fold;  of  course  this  will  give  two  triangular 


ROLLER  BANDAGE  II 

bandages.  While  made  triangular  bandages  may  be  readily 
bought,  the  only  advantage  they  possess  is  that  most  of  them 
have  pictures  showing  methods  of  application  stamped  upon 

them. 
The  triangular  bandage  may  be  applied  in  two  ways: 
Unfolded. 
Folded. 
Unfolded  means  that  the  bandage  is  used  in  the  form  of  the 
whole  triangle. 

To  fold,  the  point  of  the  triangle  is  brought  to  the  middle  of 
the  opposite  side,  and  then  the  bandage  is  folded  lengthwise  to 
the  width  desired.  When  folded  so  as  to  make  a  narrow  strip 
the  bandage  is  called  a  cravat. 

2.  Roller  Bandage.— The  roller  bandage  is  invaluable  for  the 
surgeon  but  this  is  not  the  case  with  the  first  aider.  The 
latter  must,  however,  know  how  to  make  use  of  any  appliance  at 
hand,  and  he  is  very  likely  in  an  accident  to  find  it  much  more 
convenient  to  obtain  the  roller  bandage  so  it  is  well  that  he  should 
know  the  principles  of  its  application. 

Roller  bandages  are  usually  made  of  muslin,  cotton  cloth, 
flannel,  gauze  or  cheese  cloth,  and  they  may  be  improvised  by 
tearing  strips  from  a  sheet  and  rolling  them  up.  By  far  the  best 
material  is  gauze  or  cheese  cloth.  This  is  elastic  and  fits  itself 
well  to  the  part  to  be  bandaged  so  that  bandages  made  of  it  are 
easy  to  apply  and  do  not  have  the  disadvantages  of  inelastic 
bandages  of  muslin,  which  in  unskilled  hands  are  very  apt 
either  to  be  pulled  so  tight  on  one  edge  that  they  cut  off  the  cir- 
culation or  to  be  so  loose  that  they  will  not  stay  in  place.  ^ 

While  roller  bandages  may  usually  be  readily  bought,  it  is  well 
to  know  how  they  should  be  rolled.  One  end  of  the  bandage 
should  be  turned  over  for  a  distance  of  about  6  inches,  this  lap 
should  be  folded  on  itself  and  this  process  should  be  repeated 
till  a  small  hard  roll  is  formed.  Then  place  the  bandage  on  the 
thigh  (the  foot  should  be  on  a  stool  or  chair  so  that  the  thigh  is 
nearly  at  right  angles  to  the  body)  with  roll  of  bandage  near  the 
body,  length  of  bandage  at  bottom  of  roll  and  bandage  extending 
down  the  thigh.    Roll,  beginning  with  the  fingers  of  right  hand 


12  BANDAGES 

running  down  to  the  wrist,  and  repeat  till  bandage  is  completely 
rolled.     The  left  hand  is  used  to  hold  the  bandage  tight  and  even. 
The  bandage  when  completed  should  be  in  a  hard  roll  with  even 
edges.    It  may  be  fastened  with  a  couple  of  pins. 
Roller  bandages  are  preferably  used  in  the  following  sizes: 

For  the  finger,  f  of  an  inch  wide  and  i  yard  long. 

For  the  arm  and  head,  2\  inches  wide  and  4  to  6  yards  long. 

For  the  leg  and  thigh,  3  inches  wide  and  6  to  8  yards  long. 

For  the  chest  and  abdomen,  4  to  5  inches  wide  and  8  to  12  yards 
long. 

The  bandage  2§  inches  wide  and  4  to  6  yards  long  is  the  most 
generally  used. 

While  it  is  not,  of  course,  absolutely  necessary  to  use  the  band- 
age best  adapted  in  size  for  the  part  to  which  it  is  to  be  applied, 
it  is  very  difficult  to  bandage  satisfactorily  a  small  part  with  a 
wide  bandage.  Any  bandage  when  rolled  may  be  easily  cut 
through  with  a  sharp  knife  and  thus  a  bandage  of  the  required 
size  may  always  be  obtained. 

The  roller  bandage  is  applied  by  holding  the  roll  in  the  right 
hand,  the  loose  end  being  in  the  left,  and  laying  the  outer  side  of 
the  end  on  the  place  where  it  is  desired  to  start  the  bandage. 

The  simplest  method  of  application  is  the  Circular,  but  this 
can  be  used  only  when  the  part  to  be  bandaged  is  of  nearly  the 
same  circumference  throughout.  This  is  the  case  with  the 
forearm  above  the  wrist,  and  with  the  fingers.  In  first-aid  work, 
however,  the  roller  bandage  is  usually  applied  to  hold  splints 
or  dressings  in  place  which  much  extends  the  field  of  the  cir- 
cular method  of  application  as,  especially  with  splints,  an  even 
circumference  is  likely  to  be  presented.  The  circular  method 
is  also  more  often  available  with  gauze  bandages,  for  on  account 
of  their  elasticity  they  adapt  themselves  to  slight  pulling  much 
better  than  do  bandages  made  of  stiffer  cloth.  The  circular 
method  of  application  consists  simply  of  a  series  of  circular  turns 
from  below  upward,  each  turn  overlapping  the  upper  third  of 
the  one  below. 

Where  the  part  is  larger  at  one  end  than  the  other,  at  the  start 
a  few  turns  should  be  made  round  and  round  one  over  the  other, 


BANDAGES 


13 


THE  ROLLER  BANDAGE 


1.  The  Circular 


2.  The  Reverse 


3.  The  Figure-8 


THE  FOUR-TAILED  BANDAGE 

Best  Ute  a  Piece  of  Cloth  Six  or  Eight  Inche.  Wide  and  Three  Feet  Loef     Two  to  Four 
Inche*  thould  be  left  in  Center. 


4.  Bandage  for  Forehead 


7.  Bandage  for  Nose 


6.  Bandage  for  Back 
of  Head 


8.  Bandage  for  Jaw.    (This 

is  an  excellent  Bandage  for 
Fracture  of  the  Jaw) 


Plate  I.— Bandages. 


14  BANDAGES 

then  begin  to  move  up  the  limb,  using  the  circular  method  as 
long  as  a  turn  overlaps  the  preceding  one  about  one-third.  It 
will  be  found  as  soon  as  the  limb  increases  much  in  size  that  if 
the  bandage  lies  flat,  uncovered  spaces  will  be  left.  To  prevent 
these  spaces  the  Reverse  must  be  employed.  The  Reverse  is 
generally  considered  to  be  the  most  difficult  point  to  learn  in 
the  application  of  any  bandage. 

To  make  the  Reverse,  place  the  thumb  of  the  left  hand  on  the 
lower  edge  of  the  bandage  to  hold  it  in  place,  slacken  the  bandage 
between  the  hands  (about  3  inches)  and  turn  the  roller  one-half 
over  toward  you.  Pass  the  roller  under  the  limb  keeping  the 
lower  edge  of  the  bandage  parallel  with  that  of  the  turn  below, 
reverse  again  at  the  proper  point  and  so  on.  The  reverses  should 
be  made  so  they  lie  in  the  center  of  the  limb  or  to  its  outer  side 
and  all  reverses  should  be  in  one  line  up  the  limb. 

The  Jigure-of-S  bandage  is  found  specially  useful  about  joints. 
It  consists  of  a  series  of  loops  each  overlapping  the  one  below 
by  about  two-thirds  the  width  of  the  bandage.  The  middle  part 
is  over  the  bend  of  the  joint  while  the  loops  lie  one  below  the 
other  above  it. 

The  spica  bandage  is  a  modification  of  the  figure-of-8  bandage, 
having  one  loop  much  larger  than  the  other. 

A  very  valuable  exercise  in  the  application  of  the  roller  bandage 
is  afforded  in  bandaging  the  leg  from  the  foot  to  include  the  hip. 
This  gives  an  opportunity  to  practise  all  the  methods  of  applica- 
tion which  have  been  described. 

For  those  unskilled  in  bandaging,  lengths  may  be  cut  from  a 
roller  bandage  and  these  may  be  tied  or  pinned  in  place  in  the 
same  way  that  the  folded  triangular  bandage  is  used.  Some 
special  bandages  made  in  this  way  from  the  roller  are  described 
in  the  proper  place. 

3.  Four-tailed  Bandage. — This  is  especially  useful  for  frac- 
tures of  the  lower  jaw  and  injuries  of  the  head.  Preferably  a 
piece  of  cloth  5  to  8  inches  wide  and  from  2  to  3  feet  long  should 
be  used.  It  should  be  doubled  on  itself  and  torn  from  each  end 
until  a  piece  about  4  inches  long  is  left  undivided  in  the  middle. 


HOW   TO   FASTEN  BANDAGES  I  5 

The  4-inch  roller  can  be  used  to  make  this  bandage  for  the  lower 
jaw;  it  is  rather  too  narrow  for  the  head.  The  four-tailed  band- 
age is  made  from  it  exactly  as  described  above. 

How  to  Fasten  Bandages 

Triangular  and  four-tailed  bandages  are  usually  completed 
by  tying  the  ends  together  securely  though  they  may  be  pinned, 
and  frequently  with  triangular  bandages  flaps  are  held  in  place 
by  pinning.  The  free  end  of  the  roller  bandage  is  usually  turned 
over  and  pinned  in  place.  Other  pins  are  frequently  used  to 
hold  the  different  layers  of  the  roller  bandage  from  slipping. 
A  convenient  method  sometimes  employed  in  securing  a  roller 
bandage  is  to  rip  the  bandage  down  the  center,  then  to  tie  a  knot 
to  prevent  further  ripping  and  carrying  the  ends  around  the  limb 
in  opposite  directions,  tie. 

Knots  should  be  placed  where  they  do  not  cause  discomfort 
and  where  they  may  be  easily  reached.  If  you  know  the  reef 
knot  use  it,  if  not,  three  knots  are  quite  as  secure.  Safety  pins 
are  better  than  ordinary  pins  as  they  hold  better  and  scratching 
is  prevented. 

Precautions 

Whatever  the  bandage  used,  care  must  be  taken  that  it  is  not 
put  on  too  tightly.  It  must  not  be  so  tight  that  it  constricts 
at  any  point,  for  this  will  cut  off  the  blood  supply,  and  if  the 
bandage  is  left  in  place  for  some  time  even  so  severe  an  injury  as 
mortification  or  actual  death  of  the  part  below  may  be  caused. 
Pain,  swelling  and  blueness  or  coldness  of  limb  below  the  band- 
age show  that  the  bandage  is  too  tight  and  should  be  loosened 
or  removed. 

Always  bandage  firmly,  but  never  too  tightly  or  loosely. 

Always  in  bandaging  a  limb,  leave  the  tips  of  the  fingers  or  of 
the  toes  uncovered  so  that  they  may  be  seen. 

Always  place  the  part  to  be  bandaged  in  the  position  in  which 
it  is  intended  to  leave  it,  as  otherwise  change  of  position  may 
result  in  cutting  off  the  circulation  by  drawing  the  bandage  too 
tight  at  some  point. 


1 6  BANDAGES 

Never  put  on  a  bandage  under,  but  always  over  a  splint. 

Always  in  applying  a  bandage  immediately  after  an  injury, 
remember  that  there  may  be  swelling  and  use  care  in  order  that 
the  bandage  may  not  become  too  tight  from  this  cause;  always 
be  ready  to  remove  or  to  loosen  a  bandage  when  such  swelling 
makes  it  too  tight. 

Never  apply  a  bandage  wet,  for  as  it  dries  it  will  shrink  and 
become  too  tight. 

Always  bandage  from  below  upward  with  the  roller  bandage. 

Never  reverse  the  roller  bandage  over  a  sharp  bone  and  always 
use  the  figure-of-eight  over  a  joint. 

Uses  of  Bandages 

Bandages  are  used: 

i .  To  keep  dressings  in  place. 

2.  To  hold  splints  in  place. 

3.  To  stop  bleeding  by  pressure. 

4.  As  slings. 

Application  of  Bandages 

Head  Bandages. — Fold  a  hem  about  i§  inches  wide  at  the  long 
side  of  the  unfolded  triangular  bandage.  Place  the  bandage 
so  that  the  hem  lies  squarely  across  the  forehead  just  above  the 
eyes  and  the  bandage  is  over  the  head  with  the  point  hanging 
down  the  back.  Carry  the  two  ends  around  the  head  above  the 
ears,  cross  at  the  back  and  tie  them  across  the  forehead.  Draw 
the  point  down  tight,  turn  it  up  and  pin  it  at  the  top  of  the  head 
with  a  safety  pin.     (Plate  II.) 

This  is  a  useful  bandage. 

The  four-tailed  bandage  is  also  useful  as  a  head  bandage.  It 
is  applied  in  three  ways.  For  the  front  of  the  head  the  center 
of  the  bandage  is  placed  on  the  forehead  and  the  ends  crossed 
are  tied  at  the  back  of  the  head  and  under  the  chin;  for  the  top 
of  the  head  the  center  of  the  bandage  is  placed  there  and  the 
ends  crossed  are  tied  low  at  the  back  and  under  the  chin;  for  the 
back,  center  is  put  at  back  of  the  head  and  the  ends  crossed,  are 
tied  at  forehead  and  under  chin.     (Plate  I.) 


BANDAGES 


17 


TRIANGULAR  BANDAGE 
This  Bandage  may  be  folded  into  a  scarf  and  used  on  any  part  of  the  body, 


7.  Arm  Sling 


8.  Arm  Sling  from  Shirt  Sleeve 


Plate  II. — Bandages. 


I 8  BANDAGES 

Eye  Bandage. — Place  the  center  of  the  cravat  made  from  the 
triangular  bandage  over  the  injured  eye,  bring  the  ends  to  the 
back  of  the  head  and  tie.  (Plate  II.)  A  length  cut  from  the 
roller  bandage  may  be  used  in  the  same  way. 

Nose  Bandage. — Four-tailed.  Place  center  on  nose,  cross 
ends,  carry  one  pair  below  and  other  above  ear  and  tie  both  at 
back  of  head. 

Jaw  Bandage. — For  this,  two  cravats  are  necessary  if  made 
from  triangular  bandage.  Apply  the  center  of  the  first  across 
the  chin  in  front,  bring  the  ends  to  the  back  of  the  neck  and  tie. 
Place  the  center  of  the  second  cravat  under  the  chin,  cross  the 
ends  over  the  top  of  the  head,  bring  them  down  and  tie  under 
the  chin. 

An  excellent  bandage  for  the  jaw  may  also  be  made  from  the 
four-tailed  bandage.  The  center  is  placed  with  its  middle  at  the 
point  of  the  chin  and  the  ends  are  crossed,  one  pair  being  tied 
at  the  top  of  the  head  and  the  other  at  the  back  of  the  neck. 

A  single  wide  cravat  may  be  placed  under  the  chin,  with  the 
ends  carried  to  the  top  of  the  head  and  tied  there  or  a  length 
from  a  roller  may  be  used  in  the  same  way. 

Neck  Bandage. — The  center  of  the  cravat  of  the  triangular 
bandage  or  of  a  length  from  a  roller  bandage  is  placed  over  the 
injured  place  and  the  ends  are  carried  around  the  neck  and  tied 
as  convenient.  This  bandage  may  sometimes  be  improved  by 
the  use  of  a  cardboard  support  which  is  held  firmly  in  place  be- 
tween the  layers  of  the  bandage. 

Chest  and  Shoulder  Bandage. — The  triangular  unfolded  is 
used.  The  long  side  is  placed  horizontally  across  the  chest,  the 
upper  end  is  brought  over  the  shoulder,  and  the  ends  are  tied 
at  the  back. 

Chest  and  Pelvis  Bandage. — A  wide  roller  is  applied  around 
and  around  the  body.  Triangles  in  the  form  of  cravats  may 
also  be  used.     (Plate  VIII.) 

Hand  Bandage. — The  triangular  bandage  is  spread  out.  The 
hand  is  placed  on  it,  palm  down,  with  the  fingers  toward  the 
point  (if  desired,  the  hand  may  be  closed),  and  the  wrist  is  at 
the  long  side.    The  point  is  then  brought  over  the  back  of  the 


BANDAGES 


19 


TRIANGULAR  BANDAGE 


1- Banda^efor  Chest       2.  Bandage  for  Oat         3.  *„„  Sag  «*^>  4.  Arm  Sling  ,e-*- , 


5.  Bandage  for  Hand 


€.  Bandage  for  Hand  <x> 


7.  Bandage  for  Hand  1 


8.  Bandage  for  Foot 


Plate  III. — Bandages. 


20  BANDAGES 

hand  to  the  back  of  the  wrist  and  the  two  ends  are  crossed  over 
the  wrist  and  tied. 

Bandage  for  Palm  of  Hand. — Place  the  center  of  the  cravat 
on  the  palm  of  the  hand,  cross  the  ends  at  the  back  of  the  hand 
and  again  at  the  front  of  the  wrist  and  tie  at  the  back  of  the 
wrist.     (Plate  II.) 

Crotch  Bandage. — This  is  the  T  bandage.  It  is  made  from 
two  lengths  of  a  3-inch  roller  bandage.  To  the  center  of  one  of 
these,  1  \  yards  long,  is  sewed  or  pinned  at  right  angles  the 
other,  which  is  1  yard  long.  The  bandage  is  applied  by  placing 
the  long  strip  around  the  waist  with  the  short  one  at  the  middle 
of  the  back.  The  long  strip  is  then  pinned  in  front  and  the  short 
strip  is  brought  forward  between  the  legs  to  join  the  long  one  at 
the  center  in  front  where  it  is  pinned. 

Foot  Bandage. — Spread  out  triangular  bandage.  Place  foot 
in  center  with  toes  toward  point.  Raise  point  over  toes  to 
instep  in  front.  Bring  both  ends  forward,  cross  them  over 
instep  and  tie  them  round  the  ankle. 

Bandages  for  Splints  and  Dressings. — When  roller  bandages 
are  used  to  hold  splints  or  dressings  in  place  they  are  wound 
around  and  around  in  the  manner  already  described.  For  the 
same  purpose  cravats  are  made  of  triangular  bandages. 
These  are  simply  carried  around  the  splint  or  dressing  and  the 
limb,  body  or  head  and  are  tied  in  place.  The  number  of  cravats 
is  dependent  on  the  length  of  the  splint  or  dressing. 

Slings. — 1.  Arm  slings: 

Place  one  end  of  a  triangular  bandage  over  shoulder  of  unin- 
jured side.  Allow  length  of  bandage  to  hang  down  in  front 
of  chest  so  that  point  of  triangle  will  be  behind  elbow  of  injured 
arm.  Bend  elbow  of  injured  arm  to  a  right  angle.  This  will 
bring  forearm  across  middle  of  bandage.  Then  carry  lower  end 
of  the  bandage  over  the  shoulder  of  the  injured  side  and  tie  to 
the  upper  end  behind  the  neck.  Bring  the  point  of  the  bandage 
at  the  elbow  forward  to  the  front  and  pin  there  so  that  bandage 
is  snug  but  does  not  pull. 

This  makes  an  excellent  arm  sling,  but  even  without  a  bandage 
a  good  sling  may  be  made  for  the  arm  by  pinning  the  sleeve  or 


PRACTICAL   EXERCISES  21 

the  skirt  of  the  coat  to  the  front  of  the  coat.  The  shirt  may  be 
used  in  the  same  way. 

The  cravat  may  also  be  used  for  an  arm  sling.  For  this  pur- 
pose it  is  employed  in  the  form  of  a  loop  which  encircles  the  fore- 
arm bent  at  a  right  angle  and  the  neck. 

Still  another  arm  sling  is  made  from  the  roller  bandage.  For 
this  a  3-  or  4-inch  roller  is  required,  preferably  the  latter. 
Bend  the  forearm  on  the  arm  at  the  angle  at  which  it  is  desired 
to  hold  it;  this  is  usually  about  a  right  angle.  Put  the  end  of  the 
roller  about  midway  between  the  forearm  and  shoulder  and  hold 
for  a  moment  to  get  length  required  when  it  may  be  allowed  to 
drop.  But  before  doing  so  pass  roller  in  front  and  under  forearm 
just  in  front  of  the  elbow.  Then  carry  roller  along  front  of  chest 
to  the  shoulder  on  the  injured  side,  over  this  shoulder  to  back 
of  neck,  in  front  of  sound  shoulder,  down  to  make  loop  for  hand, 
back  over  sound  shoulder,  back  of  neck  and  in  front  of  shoulder 
of  injured  side  to  starting  point  where  length  required  will  be 
cut  off  and  the  ends  will  be  tied  together.  Two  loops  have,  of 
course,  been  made,  one  for  the  forearm  near  the  elbow  and  the 
other  for  the  hand. 

QUESTIONS 

1.  What  are  the  different  kinds  of  bandages? 

2.  What  are  the  advantages  of  the  triangular  bandage  for  first-aid 
purposes? 

3.  What  is  the  size  of  the  triangular  bandage? 

4.  What  is  the  best  material  for  the  roller  bandage? 

5.  Sizes  of  the  roller  bandage  for  different  parts  of  the  body. 

6.  What  are  the  spica  and  the  figure-of-eight  bandages  used  for? 

7.  How  would  you  make  a  four-tailed  bandage? 

8.  What  precautions  must  be  taken  in  putting  on  bandages? 

9.  For  what  purposes  are  bandages  used? 

PRACTICAL  EXERCISES 

Show  the  different  bandages  and  how  the  triangular  bandage  is 
used,  unfolded,  folded  and  as  a  cravat. 

Put  bandages  on  the  different  parts'of  the  body  and  show  how  they 
are  used  to  keep  splints  and  dressings  in  place  and  as  slings. 

As  much  practice  in  bandaging  by  the  class  as  time  permits. 


CHAPTER  III 

INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR 
BROKEN 

Bruises,    Strains,    Sprains,    Dislocations  and  Fractures 

These  are  the  commonest  injuries  and  no  one  can  hope  not  to 
suffer  from  some  of  them.  Of  course  many  bruises  and  strains 
are  unimportant. 

Causes. — These  injuries  are  all  caused  by  violence  in  the  form 
of  blows  or  falls,  or  by  wrenching  the  body. 

This  does  not  apply  to  all  compound  fractures,*  however,  as 
will  be  seen  later. 

Prevention. — These  injuries  Occur  under  so  many  different 
circumstances  that  it  is  impossible  to  suggest  other  than  the  most 
general  means  for  preventing  them.  It  is  safe  to  say,  however, 
that  a  great  many  of  them  result  from  carelessness  and  that 
especially  in  dangerous  places,  people  should  be  more  alive  to 
their  surroundings.  In  other  words,  they  should  always  exercise 
common  care. 

Posted  directions  should  always  be  observed,  Such  directions 
are  not  arbitrary,  as  they  are,  unfortunately,  sometimes  regarded, 
but  represent  the  teachings  of  experience. 

Structure  and  Mechanics  of  the  Body. — Before  studying  these 
injuries  it  will  be  necessary  to  know  something  of  how  the  body 
is  made.  The  body  has  both  hard  and  soft  parts.  The  bones 
are  the  hard  parts  and  the  muscles  and  the  internal  organs,  such 
as  the  heart,  lungs,  liver,  etc.,  constitute  the  soft  parts. 

*  Compound  fractures  are  more  conveniently  described  under  frac- 
tures, though  properly  they  are  wounds  and  first  and  foremost  require 
the  treatment  of  such  injuries. 


BONES  23 


BONES 


The  bones  are  hard  and  firm  and  together  make  up  the  Skeleton. 
The  skeleton — 

Forms  a  strong  and  rigid  frame-work  for  the  body. 

Supports  and  carries  the  soft  parts. 

Protects  vital  organs  from  injury. 

Gives  attachment  to  muscles. 

Forms  joints  so  that  movements  are  possible. 
The  skeleton  is  divided  into  three  parts: 

1.  The  Head,  made  up  of  the  Cranium,  a  bony  case  which  en- 
closes and  protects  the  brain;  and  the  Face,  with  the  eyes,  ears, 
nose  and  mouth.  The  only  movable  bone  in  the  head  is  the 
lower  jaw. 

2.  The  Trunk,  which  is  divided  into  two  parts  by  a  muscular 
partition — the  diaphram.  The  upper  portion  is  the  Chest,  which 
contains  the  esophagus  or  gullet,  the  lungs,  the  heart  and  some 
large  blood-vessels.  The  lower  portion  is  the  Abdomen,  in  which 
are  found  the  stomach,  liver,  kidneys,  bladder,  the  intestines  and 
other  organs. 

The  trunk  is  formed  of  several  bones  which  are  of  interest  to  the 
first-aid  student. 

The  Spinal  Column,  &  strong  pillar  with  several  curves,  is  made 
up  of  a  number  of  bones  called  vertebrae  with  a  softer  substance 
called  cartilage  between  them.  At  its  lower  end,  the  spinal 
column  terminates  in  the  broad  Sacrum  or  Rump  Bone  and  the 
pointed  Coccyx.  The  spinal  column  supports  the  head  and  the 
ribs,  and  is  itself  supported  on  the  pelvis. 

The  Ribs,  12  in  number,  form  the  greater  part  of  the  walls  of 
the  chest.  All  the  ribs  are  connected  to  the  spinal  column  be- 
hind, but  the  two  lower  ones  on  each  side  are  shorter  than  the 
others  and  are  not  connected  to  anything  in  front.  The  10  upper 
ones  on  each  side  are  united  to  the  Breast-bone. 

The  Breast-bone  or  Sternum  is  a  flat,  dagger-shaped  bone  which 
forms  the  front  on  the  chest.  Above  it  forms  joints  with  the 
Collar-bones,  or  Clavicles,  being  notched  for  the  purpose  on  each 
side. 


24        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 


Plate  IV. — The  skeleton.     {Holden.) 


JOINTS  25 

The  Pelvis  is  a  wide,  strong,  bony  basin  formed  of  the  Haunch 
bones  at  the  front  and  sides  and  partly  behind  where  it  is  closed 
by  the  sacrum  and  coccyx.  It  supports  the  trunk  and  forms 
joints  with  the  lower  limbs. 

3.  The  Upper  and  the  Lower  Limbs. — Each  upper  limb  is 
made  up  of  the  Scapula  or  Shoulder-blade,  a  flat,  triangular  bone 
at  the  back  of  the  shoulder;  the  Clavicle  or  Collar-bone,  a  curved 
long  bone  placed  horizontally  across  the  upper  part  of  the  chest 
above  the  first  rib;  the  Humerus,  the  bone  of  the  upper  arm;  the 
Radius  and  the  Ulna,  the  two  bones  of  the  forearm;  and  the 
Hand,  which  has  8  small,  irregular  bones  in  the  Carpus  or  wrist, 
five  Metacarpal  Bones  for  the  hand  itself,  and  14  bones,  Pha- 
langes, in  the  fingers  and  thumb. 

Each  lower  limb  is  made  up  of  the  Femur  or  Thigh-bone;  the 
Patella  or  Knee-cap;  the  Tibia  and  Fibula,  the  two  leg  bones; 
and  the  Foot.  The  foot  is  made  up  of  the  Tarsus,  with  seven 
irregular  bones,  which  form  the  heel,  part  of  the  ankle,  and  the 
instep,  5  Metatarsal  Bones  for  the  middle  of  the  foot;  and  the 
toes  with  14  bones,  Phalanges. 

The  principal  interest  which  bones  have  for  the  student  of  first 
aid  is  that  they  may  be  broken  or  fractured,  one  of  the  commonest 
accidents. 


JOINTS 

Wherever  two  or  more  bones  are  in  contact  or  touch  each  other 
they  form  a  joint.  The  ends  of  bones  forming  a  joint  are  covered 
with  a  smooth  substance  called  cartilage  or  gristle,  so  that  they 
may  move  without  friction  on  each  other.  Joints  are  hermeti- 
cally, closed  by  a  flexible  sac,  the  capsule,  which  secretes  an  oily 
fluid.  This  fluid  lubricates  a  joint  just  as  oil  does  an  engine. 
The  ligaments  of  a  joint  are  strong,  fibrous  bands  which  hold  the 
bones  together.  The  most  important  joints  to  study  are  the  hip 
and  shoulder,  which  are  ball-and-socket  joints  having  movements 
in  all  directions,  and  the  elbow,  wrist,  knee  and  ankle,  hinge 
joints.  These  have  only  to  and  fro  movement  like  an  ordinary 
hinge. 


26        INJURIES  IN  WHICH  THE  SKIN' IS  NOT  PIERCED  OR  BROKEN 

Joints  are  of  importance  to  the  student,  as  bones  are  liable  to 
be  put  out  of  place  or  dislocated  at  the  joints. 

MUSCLES 

The  movements  of  bones  at  the  joints  are  caused  by  the  Muscles. 

The  muscles,  the  flesh  or  meat,  form  two-fifths  of  the  body  by 
weight.  They  are  made  up  of  red  fibers  which  have  the  power 
of  shortening  or  contracting,  so  that  if  one  end  of  a  muscle  is  fixed 
and  the  muscle  is  contracted  the  other  end  will  pull  on  and  move 
whatever  it  is  attached  to.  By  doing  this  muscles  cause  all  the 
movements  of  the  body.  For  example,  the  biceps,  the  big  muscle 
at  the  front  of  the  upper  arm,  in  contracting  causes  the  elbow- 
joint  to  bend  by  bringing  the  forearm  closer  to  the  upper  arm. 
All  muscles  are  somewhat  on  the  stretch,  as  otherwise  prompt 
movement  would  be  impossible.  Some  of  the  muscles  are 
attached  to  bones  by  Tendons  or  Sinews.  These  are  strong, 
fibrous  cords.     They  may  be  well  seen  in  the  wrist. 

Muscles  are  of  great  interest  both  in  fractures  and  in  disloca- 
tions, as  their  pulling  causes  displacements  and  their  resistance 
offers  the  chief  obstacle  to  setting  fractures  and  to  reducing 
dislocations. 

SUBCUTANEOUS  TISSUE 

This  name  is  given  to  the  fatty  layer  or  padding  which  lies 
immediately  beneath  the  skin.  In  this  are  found  many  small 
blood-vessels  and  nerve  endings.  The  force  of  a  blow  or  fall  is 
often  expended  on  this  tissue. 

The  injuries  which  will  now  be  spoken  of  affect  the  structures 
of  the  body  which  have  just  been  described. 

BRUISES 

Description. — These  are  the  commonest  injuries.  When  a 
person  falls  and  strikes  some  part  of  his  body  or  when  he  is 
struck  by  something,  usually  the  skin  in  not  broken,  but  the 


MUSCLES 


27 


Plate  V. — The  muscles.     (Brubaker.) 


28       INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

force  of  the  blow  or  fall  injures  the  subcutaneous  tissue,  which  lies 
immediately  beneath  the  skin,  breaking  numbers  of  small  blood- 
vessels therein.  Blood  escapes  from  these  small  vessels  and  this 
causes  the  swelling  and  the  ordinary  black-and-blue  spot  which 
is  due  to  the  blood  which  has  escaped. 

Causes. — Blows  or  falls. 

Symptoms. — Pain  at  once  from  injury  to  nerves.  Swelling 
from  escape  of  blood  from  blood-vessels.  Black-and-blue  spot 
from  same  cause.  Pain  also  later  from  pressure  of  this  blood 
on  sensitive  nerves. 

Pain  is  increased  by  movement. 

Treatment. — Slight,  no  treatment.  More  severe,  object  is 
to  limit  swelling  and  to  decrease  pain.  At  once:  Ice  or  very 
hot  or  very  cold  water,  or  half  alcohol  and  half  water.  Arnica 
or  witch-hazel.  These  contract  the  injured  blood-vessels  and 
so  prevent  escape  of  more  blood  and  also  deaden  the  nerves  to 
some  extent,  thus  relieving  pain.  Ice  may  be  applied  directly 
to  injured  part.  Best  in  using  liquid  remedy  to  wet  cloth  with 
liquid  and  then  to  apply  cloth.  Raising  bruised  part  diminishes 
pain,  as  it  diminished  the  blood-supply.  In  arm,  when  severe 
and  movement  is  painful,  use  a  sling.  No  doctor  is  usually 
required  for  a  bruise. 

Warning. — A  bruise  may  be  only  the  least  important  part  of 
an  injury.  So  with  a  bruise  always  try  to  make  sure  there  is 
no  other  injury,  such  as  a  broken  bone. 

Bruises  of  the  chest  and  abdomen  sometimes  result  in  internal 
injuries.  These  may  be  very  dangerous  from  breaking  of  the 
blood-vessels  of  the  lungs,  of  the  abdominal  organs,  or  from 
actual  rupture  of  the  soft  internal  structures.  Severe  bruises  of 
this  character  therefore  demand  the  immediate  attention  of  a 
physician.  In  case  shock  is  very  severe  after  a  bruise  of  the 
abdomen  or  chest,  serious  injury  of  the  internal  organs  should  be 
suspected. 

STRAINS 

Description. — A  strain  is  the  name  given  to  the  injury  produced 
by  overstretching  of  a  muscle.     In  severe  strains  small  blood- 


SPRAINS  29 

vessels  in  the  muscles  are  often  broken  so  that  blood  escapes 
into  the  muscles  in  the  same  way  that,  with  a  bruise,  blood 
escapes  into  the  subcutaneous  tissue.  The  commonest  strains 
are  of  the  muscles  of  the  back  and  shoulders  and  of  the  small 
tendons  of  the  wrist  and  ankle. 

Cause. — Usually  a  sudden  wrench — may  be  due  to  lifting 
too  heavy  a  weight. 

Symptoms. — Pain,  increased  on  movement.  Stiffness. 
Lameness.     More  or  less  swelling. 

Treatment. — Not  necessary  to  call  doctor  unless  severe. 
Absolute  rest  at  first.  Alcohol  and  water,  arnica  or  witch  hazel 
gently  rubbed  in  to  deaden  pain.  In  both  upper  and  lower 
limbs,  rubDing  should  always  be  toward  the  body.  Later  such 
rubbing  may  be  harder  to  help  absorption  and  to  make  strained 
muscles  more  supple.  When  pain  and  stiffness  are  less,  gentle 
movement  should  be  practised  until  both  have  entirely 
disappeared. 

SPRAINS 

Description. — Sprains  are  injuries  of  joints.  They  result 
from  violent  stretching,  twisting  and  partial  breaking  of  the 
ligaments  about  a  joint  and  are  sometimes  accompanied  by  actual 
breaking  of  the  bones.  The  twisting  or  stretching  results  in 
breaking  of  the  blood-vessels  and  the  escape  of  blood  and  of 
blood-serum  (the  liquid  part  of  the  blood)  both  around  and 
into  the  joint.     Sprains  of  the  wrist  and  ankle  are  most  common. 

Cause. — Unnatural  movement  of  a  joint.  Sometimes  the 
cause  is  a  slight  one,  such  as  twisting  the  foot  in  stepping  down 
from  a  street  curb. 

Symptoms. — Severe  pain  immediately.  Pain  is  much  in- 
creased by  movement  of  the  joint.  Swelling  of  joint.  Bones 
are  not  out  of  place  and  appearance  of  joint  is  unchanged  except 
for  the  swelling.     Shock  when  severe. 

Treatment. — Call  doctor  always  when  severe  or  when  in  doubt. 
Always  begin  treatment  at  once  whether  doctor  has  been  called 
or  not.     Absolute  rest  in  order  not  to  do  more  damage  by 


30        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

rubbing  of  the  injured  joint  surfaces  together.  This  means  that 
the  patient  should  not  be  allowed  to  move  the  joint  or  to  step  on 
it.  Elevate  joint  when  possible  and  apply  heat  or  cold.  Less 
blood  will  come  to  the  injured  joint  if  it  is  elevated  and  heat  or 
cold  contracts  the  blood-vessels  and  thus  limits  the  escape  of 
blood  and  serum.  Cold  may  be  applied  in  the  form  of  snow  or 
crushed  ice  in  a  cloth.  It  is  usually  better  to  use  cloths  wrung 
out  in  very  hot  or  very  cold  water  or  to  shower  the  joint  with 
very  hot  or  cold  water.  Putting  sprained  joint  under  a  cold  or 
hot  water  tap  is  also  excellent. 

Either  heat  or  cold  should  be  made  use  of  sufficiently  long  to 
get  full  benefit  from  it,  that  is  to  say,  from  24  to  48  hours.  At 
first  on  the  application  of  either  heat  or  cold,  the  pain  may- 
increase,  but  after  an  hour,  at  the  latest,  it  will  commence  to 
improve  and  will  finally  disappear.  Remember  there  may  be 
shock  and,  if  so,  treat. 

Warning. — A  severe  sprain,  especially  a  sprain  of  the  ankle, 
is  by  no  means  a  trivial  injury  but  one  which  demands  the  ser- 
vices of  a  physician. 

DISLOCATIONS 

Description. — Dislocations  are  injuries  of  joints  and  are  due 
to  the  head  of  a  bone  slipping  out  of  its  socket.  A  dislocation 
cannot  occur,  except  in  a  joint  which  has  been  dislocated  before, 
without  tearing  the  ligaments  which  keep  the  bones  of  the  joint 
close  together.  Some  persons,  however,  on  account  of  frequent 
dislocations  of  the  same  joint  have  its  ligaments  so  stretched 
that  not  only  is  dislocation  easy,  but  no  further  injury  of  the 
ligaments  results  from  it.  By  far  the  most  frequent  dislocation 
is  that  of  the  shoulder-joint,  which  occurs  in  one-half  of  all  cases 
of  dislocation.  But  dislocations  of  the  hip-joint,  the  jaw  and  the 
fingers  are  not  particularly  uncommon. 

Causes. — Dislocations  are  usually  caused  by  a  blow  or  a  fall, 
but  sometimes  result  from  a  violent  muscular  effort,  such  as 
throwing  a  stone. 

Symptoms. — Deformity;  that  is,  the  joint  has  an  unusual 


DISLOCATION   OF   LOWER   JAW  31 

appearance,  because  the  head  of  the  bone  is  not  in  its  proper 
place.  This  may  be  best  seen  by  comparing  the  injured  with  the 
uninjured  side  of  the  body. 

The  limb  in  which  a  joint  is  dislocated  may  be  either  longer  or 
shorter  than  the  uninjured  limb.  This  depends  on  the  direction 
in  which  the  dislocation  has  taken  place.  The  head  of  a  dis- 
located bone  may  often  be  felt  out  of  its  place.  Limited  move- 
ment as  the  displaced  head  of  the  bone  is  tightly  held  in  its  new 
position.  Pain  from  pressure  by  the  displaced  head  of  the  bone 
on  sensitive  nerves.  Swelling  from  bruising  of  the  soft  parts 
by  the  displaced  head  of  the  bone  but  is  often  not  noticeable. 
Shock. 

Treatment.— Send  for  a  doctor  at  once.  Treat  shock  if  neces- 
sary. Always  await  the  doctor's  arrival  except  in  dislocation 
of  the  jaw,  the  fingers,  and  the  shoulder,  without  attempting  to 
put  the  head  of  the  bone  back  in  its  proper  place.  This  is  called 
reducing  a  dislocation. 

Remember  that  attempts  to  reduce  dislocations,  other  than 
those  of  the  finger  and  jaw,  by  one  without  a  doctor's  training 
may  result  in  great  harm  to  the  patient,  for  the  movements 
necessary  to  do  so  may  cause  serious  injury  to  the  blood-vessels, 
nerves  and  soft  parts. 

When  no  attempt  is  made  to  reduce  the  dislocation,  the  patient 
should  be  put  in  a  comfortable  position  and  the  injured  joint 
should  be  covered  with  cloths  wrung  out  in  very  hot  or  very 
cold  water  so  as  to  contract  the  vessels  and  to  prevent  swelling 
as  much  as  possible. 

a 

Dislocation  of  the  Lower  Jaw 

This  may  usually  be  successfully  treated  by  almost  anyone. 
This  is  fortunate,  as  a  dislocated  jaw  with  the  open  mouth  in 
consequence  is  most  painful  and  uncomfortable.  To  reduce 
a  dislocation  of  the  jaw,  both  thumbs  must  first  be  wrapped  in 
several  layers  of  cloth  so  that  they  will  not  be  liable  to  injury. 
Both  thumbs  are  then  placed  in  the  patient's  mouth  resting  on 
his  lower  teeth  on  each  side  while  the  fingers  seize  the  lower 


32        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

jaw  outside.  First  pressure  is  made  downward  and  then  back- 
ward. As  soon  as  the  jaw  starts  into  place  the  thumbs  should  be 
slid  off  the  teeth  to  the  inside  of  the  cheeks  or  they  will  be  caught 
between  the  teeth  when  the  jaw  springs  into  place.  The  over- 
stretched muscles  act  just  like  rubber  bands  and  one  must  be 
quick  or  his  thumbs  will  be  injured.  When  dislocation  is  re- 
duced put  on  jaw  bandage. 

Dislocation  of  the  Fingers 

These,  not  including  those  of  the  second  joint  of  the  thumb, 
present  no  great  difficulties  to  the  first  aider.  The  dislocated 
finger  should  first  be  grasped  firmly  on  the  hand  side.  The  end 
of  the  finger  should  then  be  pulled  straight  out  away  from  the 
hand  and  the  bone  will  usually  slip  into  place.  No  bandage 
will  be  required. 

Dislocation  of  the  Shoulder 

No  attempt  should  be  made  to  reduce  this  dislocation  if  the 
services  of  a  physician  can  be  obtained  within  a  reasonable 
time,  say  four  hours.  Make  your  decision  on  this  point  at  once, 
for  if  you  are  compelled  to  attempt  to  reduce  the  dislocation 
you  must  get  to  work  immediately  before  the  muscles  have  be- 
come set  and  rigid  from  the  irritation  caused  by  the  displaced 
head  of  the  bone. 

Frequently  little  difficulty  will  be  experienced  in  reducing  a 
dislocation  of  the  shoulder,  especially  if  the  joint  has  been  dis- 
located before.  To  accomplish  it,  the  patient  should  be  made 
to  lie  down  flat  on  his  back.  The  person  who  is  going  to  try 
to  reduce  the  dislocation  should  then  sit  down  beside  him  on 
the  injured  side  facing  toward  his  head  and  should  place  the 
heel  of  his  foot  nearest  the  injured  person,  after  the  shoe  has  been 
removed,  in  the  arm-pit  of  the  patient's  injured  side  and  then 
draw  down  the  dislocated  arm  and  drag  it  toward  the  uninjured 
side  at  the  same  time  pressing  outward  and  upward  with  the  heel. 
This  will  usually  force  the  upper  end  of  the  dislocated  bone  out- 


DISLOCATION   AXD   FRACTURE 


33 


Plate  VI. — Dislocation  and  fracture. 


34        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

ward,  and  as  soon  as  it  is  free  it  will  snap  back  into  place.  In 
order  to  keep  the  bone  in  place,  the  arm  should  then  be  band- 
aged to  the  side  with  the  forearm  carried  across  the  chest  and 
the  hand  placed  on  the  opposite  shoulder. 

Warning. — In  case  difficulty  is  experienced  in  reducing  any 
dislocation,  stop  at  once. 

FRACTURES 

Description. — When  a  bone  is  broken,  the  injury  is  called  a 
fracture.  Our  bones  are  brittle  and  when  the  force  used  against 
them  is  sufficient  they  break  much  as  would  a  dry  stick.  Frac- 
tures are  among  the  commonest  severe  injuries,  ten  times  as 
common  as  dislocations.  About  two-thirds  of  all  fractures  are 
of  the  bones  of  the  limbs.  Next  in  frequency  are  those  of  the 
collar-bone  and  ribs.  Fractures  of  the  skull,  spine  and  pelvis 
are  comparatively  rare. 

A  simple  fracture  is  one  in  which  the  skin  is  not  pierced. 

A  compound  fracture  is  one  in  which  the  skin  is  pierced. 

Causes. — Simple:  blows  and  falls.  Compound:  also — from 
bad  handling  of  simple  fractures  and  from  wounds. 

Prevention. — Simple:  as  given  under  general  heading.  Com- 
pound: also — by  proper  handling  of  simple  fractures  and  the 
prevention  of  wounds. 

Symptoms.  Simple  fracture. — The  injured  person  has  had 
a  blow  or  fall.  Pain  at  point  of  fracture.  Tenderness  at  point 
of  fracture.  Person  injured  is  unable  to  move  broken  limb. 
Deformity;  a  fractured  limb  will  be  altered  in  shape  and 
shortened  or  bent.     Always  compare  with  the  uninjured  side. 

Recognition  by  touch — an  inequality  may  often  be  felt  by 
running  finger  along  a  broken  bone. 

Loss  of  rigidity  of  bone.     On  moving  a  limb  in  which  a  bone  is 
fractured,  instead  of  the  bone  being  moved  as  a  whole  it  will  be 
noticed  that  at  the  point  of  fracture  there  is  unusual  movement 
something  like  that  of  a  hinge. 

Crepitus.  This  is  the  surgical  term  applied  to  the  grating 
which  is  heard  or  felt  when  the  broken  ends  of  the  bone  rub  on 
each  other. 


SIMPLE   FRACTURE  35 

Shock. 

Warning. — As  one  may  do  great  harm  by  moving  a  broken 
bone,  for  the  broken  ends  are  likely  to  be  very  sharp,  it  is  much 
safer  when  an  injured  person  is  unable  to  move  a  limb,  and  from 
appearances  it  seems  probable  that  a  fracture  has  occurred,  to 
conclude  that  it  is  a  fracture  without  further  examination,  and 
to  so  treat  it. 

Treatment.  Simple  Fracture. — Send  for  a  doctor.  Treat 
shock. 

The  object  of  the  further  treatment  before  the  doctor's  arrival 
is  to  prevent  more  injury,  especially  puncture  of  the  skin  by  the 
sharp,  knife-like  edges  of  the  broken  bone.  If  this  occurs  the 
simple  fracture  is,  of  course,  converted  into  a  compound  fracture. 
In  the  former  injury  there  is  no  chance  of  wound-infection  as  the 
unbroken  skin  prevents  germs  from  reaching  the  break  in  the 
bone,  while  in  the  latter  the  skin  is  cut  through  and  in  conse- 
quence germs  reach  the  broken  bone  ends  and  infection  occurs. 
So  instead  of  the  few  weeks  of  comparatively  painless  healing 
of  the  simple  fracture  without  much  danger,  a  compound  frac- 
ture is  caused  with  probable  wound  infection,  inflammation, 
pus  or  matter,  and  perhaps  months  of  sickness  from  blood- 
poisoning,  with  considerable  danger  of  death.  In  the  treatment 
of  simple  fractures  your  principal  object  is  accomplished  by 
preventing  movement  of  the  ends  of  the  broken  bone. 

If  the  doctor  may  be  expected  to  arrive  promptly,  nothing 
need  be  done  except  to  put  the  patient  in  a  comfortable  position. 
If  it  is  evident  that  in  order  to  do  this  the  broken  bone  will  be 
moved,  it  must  be  supported  firmly  by  your  hands.  One  hand 
should  support  the  broken  bone  on  each  side  of  the  break.  The 
bone  must  not  bend. 

Afterward  the  broken  bone  had  best  be  supported  in  the  natural 
position  on  a  pillow  or  a  folded  coat.  In  so  supporting  it  great 
care  must  be  taken  that  it  is  not  bent  or  does  not  drag  on  the 
point  of  fracture. 

If  the  patient  must  be  moved  more  that  slightly,  as  just 
described,  the  broken  bone  must  be  set;  that  is  to  say,  it  must 
be  gently  drawn  into  its  natural  position,  always  determining 


36        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

this  by  comparing  it  with  the  opposite  side,  and  held  there  firmly 
by  splints. 

If  the  injured  person  is  wearing  thin  summer  clothing,  it  will 
not  usually  be  necessary  to  remove  the  clothing  in  order  to  exam- 
ine for  fracture.  In  fact,  it  will  be  better  not  to  try  to  do  so, 
as  this  may  result  in  injury  from  moving  the  sharp  ends  of  the 
bone,  and  when  the  clothing  is  left  on  it  furnishes  excellent 
padding  for  splints.  With  thick  clothing,  however,  very  likely 
one  will  not  be  able  to  tell  that  a  fracture  has  occurred  or  what  the 
character  of  the  injury  is.  In  this  case  never  try  to  take  off  the 
clothing,  but  cut  it  in  the  seams  with  a  sharp  knife  or  scissors. 

Symptoms.  Compound  Fracture. — Besides  the  symptoms 
already  described,  there  is  a  wound  leading  down  to  the  broken 
bone,  or  the  broken  end  of  the  bone  sticks  through  the  skin. 

Treatment.    Compound  Fracture. — i.  Send  for  doctor. 

2.  Treat  shock. 

3.  Expose  fracture  by  cutting  clothing. 

4.  Turn  back  clothing  from  wound. 

5.  Always  treat  wound  first,  then  fracture. 

6.  Do  not  touch  wound  with  fingers  or  anything  else. 

7.  As  soon  as  possible  procure  an  antiseptic  or  surgically  clean 
compress  and  place  it  on  the  wound. 

8.  Then  use  same  precautions  as  in  simple  fracture  to  prevent 
movement  of  sharp  ends  of  broken  bone.     (Splints  and  padding.) 

9.  If  a  sharp  bone  is  button-holed  through  the  skin,  as  fre- 
quently happens,  do  not  attempt  to  restore  it  to  its  place,  but 
after  dressing  wound,  hold  it  in  position  as  it  is  with  splints. 

Warning. — Never  in  any  fracture  attempt  to  transport  the 
injured  person  until  the  broken  bone  is  firmly  held  in  position 
by  splints. 

More  about  Splints. — Splints  are  used  for  fractures  and  sus- 
pected fractures.  Their  purpose  is  to  prevent  movement  at  the 
point  where  a  bone  is  broken.  They  must,  therefore,  be  made  of 
a  stiff  material.  For  first-aid  purposes  splints  must  generally 
be  improvised  from  something  which  may  easily  be  procured 
on  the  spot.     Such  articles  are  pieces  of  wood,  broom  handles, 


FRACTURES 


37 


3.  Fracture  of  Collar  Bone  4  Fracture  of  Upper  Am>       5.  Splint  and  Sling  for  Forearm 


7.  Fracture  of  Lower  Leg 


Plate  VII. — Fractures. 


38        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

lathes,  rules,  squares,  wire  netting,  heavy  cardboard,  umbrellas, 
canes,  pick  handles,  spades,  rolls  made  of  blankets  or  cloth, 
pillows  alone  or  with  pieces  of  board  outside,  rifles,  swords  and 
bayonets:  With  a  broken  leg  it  is  possible  to  use  the  other  leg 
as  a  splint. 

In  improvising  splints  a  few  precautions  should  be  observed. 
Besides  being  rigid  enough  to  prevent  movement  at  the  point 
where  a  bone  is  broken,  they  should  be  long  enough  to  prevent 
movement  at  .the  nearest  joints,  as  this  will  move  the  broken 
bone,  and  they  should  preferably  be  as  wide  as  the  limb  to  which 
they  are  applied,  as  otherwise  the  bandages  holding  them  on 
will  press  on  the  limb  as  well  as  on  the  splint  and  thus  cause 
pain  and  perhaps  displace  the  ends  of  the  broken  bone.  On 
account  of  the  danger  from  swelling  and  in  order  to  promote  the 
comfort  of  the  patient  and  not  to  rub  the  skin,  splints  should  be 
well  padded  on  the  inner  side  with  some  soft  material.  The 
clothing  sometimes  answers  this  purpose  fairly  well  when  it  is 
not  removed.  Substances  generally  used  are  cotton  batting, 
waste,  tow,  flannel,  pieces  of  cloth,  grass,  etc.  If  splints  are  not 
well  padded,  the  limb  to  which  they  are  applied  must  be  watched 
with  special  care  because  the  swelling  is  likely  to  make  the  splints 
too  tight  which  will  cut  off  the  circulation  and  may  cause  morti- 
fication. 

Special  Fractures 

Fracture  of  Upper  Arm  and  Forearm 

Symptoms. — These  fractures  may  almost  always  be  easily 
detected  by  the  symptoms  already  given. 

Treatment. — Send  for  doctor.  Treat  shock.  Gently 
straighten  limb  so  as  to  put  it  in  natural  position.  Secure  two 
splints  long  enough,  in  upper  arm  to  extend  from  shoulder 
and  arm-pit  to  elbow,  and  in  forearm  from  elbow  to  middle  of 
hand.  These  are  best  flat  boards;  shingles  are  excellent,  but 
may  be  of  any  stiff  material,  such  as  twigs,  covers  of  wine  bottles, 
tin  troughs,  etc.  Pad  splints  well.  In  upper  arm,  apply  one 
splint  to  inner  and  the  other  to  outer  side  of  arm.     Support  by 


CRUSHED    HAND    OR   FOOT  39 

sling.  In  forearm:  Place  forearm  across  the  chest,  thumb  up. 
Apply  one  padded  splint — clothing  will  do  for  padding — to 
outer  side  from  elbow  to  beyond  wrist  and  the  other  to  inner 
surface  extending  to  tips  of  fingers.     Support  by  sling. 

Broken  Wrist 

This  is  an  extremely  common  injury  resulting  from  a  fall  on 
the  hands  which  are  put  out  in  falling  forward  to  prevent  the 
body  from  striking  the  ground. 

Symptoms. — This  belongs  to  a  class  of  fractures  to  which  the 
name  impacted  is  given.  The  force  of  the  injury  actually  drives 
one  bone  into  the  other  so  that  they  are  held  together.  Great 
deformity,  no  crepitus,  movement,  etc. 

Treatment. — Send  for  doctor.  Treat  shock.  Do  not  attempt 
to  free  bones,  but  leave  them  as  they  are.  Otherwise  treat  like 
fracture  of  forearm. 

Broken  Fingers 

Symptoms. — Usual  symptoms  of  fracture,  which  is  easily 
detected. 

Treatment. — Gently  draw  into  natural  position.  Put  narrow 
padded  splint  under  finger  and  hold  it  in  place  with  a  narrow 
bandage.  Support  hand  in  sling.  Show  to  doctor  as  early  as 
practicable. 

Crushed  Hand  or  Foot 

Symptoms. — Are  due  to  a  heavy  weight  falling  on  or  passing 
over  the  hand  or  foot.  Many  or  few  of  the  bones  of  the  wrist 
and  hand  or  the  foot  and  ankle  may  be  crushed.  Usual  symptoms 
of  fracture.     Much  pain.     Great  swelling. 

Treatment. — Hand:  Apply  a  padded  splint  to  the  front  of 
the  hand.  This  should  be  as  wide  as  the  hand  and  long  enough 
to  go  from  the  middle  of  the  forearm  to  beyond  the  tips  of  the 
fingers. 

Foot:  Remove  shoe.     Padded  splints,  bottom  of  foot  from 


40        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

heel  to  toes.     A  figure-of-8  bandage  will  be  found  most  conveni- 
ent to  hold  this  in  place.     Raising  foot  will  relieve  pain. 

Fracture  of  Lower  Leg 

Symptoms. — As  given  above.  Patient  falls  to  ground.  Is 
not  usually  difficult  to  detect  fracture. 

Treatment. — Send  for  doctor.  Treat  shock.  Secure  pillow, 
sack  stuffed  like  pillow  with  hay,  straw  or  the  like  or  a  blanket 
rolled  so  as  to  make  trough.  Gently  lift  the  leg  to  pillow,  or  on 
to  the  trough  of  the  blanket,  placing  one  hand  above  and  the 
other  below  break,  under  leg,  always  holding  in  natural  position. 
Then  should  not  allow  toes  to  turn  in  or  out,  but  should  be  sup- 
ported in  same  position  as  toes  of  uninjured  leg.  Nothing  further 
unless  must  move  patient.  If  this  must  be  done  the  leg  should 
be  drawn  into  natural  position  and  splinted.  Use  two  splints 
when  procurable.  Though  any  stiff  material  may  be  used  for 
these  splints,  preferably  they  should  be  of  thin  boards  longer 
than  the  leg  so  as  to  prevent  movement  at  the  knee-joint,  and 
wider  than  the  leg  is  thick.  The  splints  may  be  applied  outside 
of  pillow,  one  at  the  inner  and  the  other  at  outer  side  of  leg. 
They  should  be  held  in  place  by  3  or  4  strips  of  cloth,  straps  or 
handkerchiefs  passed  around  splints,  pillow  and  leg  and  tied. 
Care  must  be  taken  that  none  of  these  strips  is  directly  over 
break,  as  this  will  cause  intense  pain  by  pressure.  The  pillow 
alone  makes  a  fairly  good  support  even  without  splints.  Splints 
also  may  be  used  without  a  pillow.  If  this  is  done  the  clothing, 
straw,  hay,  cotton,  leaves  or  something  else  soft  must  be  used  for 
padding  under  the  splints,  which  are  tied  in  place  in  the  way 
described  above.  In  case  of  emergency  anything  stiff  of  suffi- 
cient length,  such  as  a  cane,  umbrella  or  the  like,  may  be  used 
for  the  outer  splint,  the  other  leg  being  used  for  the  inner  splint. 
The  strips  of  cloth  or  handkerchiefs  are  then  passed  around  the 
splint  and  both  legs  and  tied  as  before. 

Fractures  of  Ttdgh 

Symptoms. — As  above,  patient  falls  to  ground.  May  be 
difficult  to  detect  fracture  on  account  of  thick  muscles. 


FRACTURE    OF   COLLAR-BONE  41 

Treatment. — The  necessity  of  procuring  a  physician  and  of 
treating  shock  are  greater  than  in  fracture  of  the  leg.  Remarks 
in  reference  to  careful  handling  of  broken  bone  in  fracture  of  the 
lower  leg,  apply.    If  difficult  to  detect  fracture,  treat  as  fracture. 

A  long  splint  extending  in  a  solid  piece  from  foot  to  arm-pit 
is  required  for  outside  splint  to  prevent  movement  of  hip-joint. 
This  should  be  firmly  fixed  by  encircling  strips  of  cloth  to  the 
chest  as  well  as  to  the  limb.  Seven  strips  will  be  required. 
Inner  splint  had  best  extend  from  crotch  to  foot.  If  no  inner 
splint  can  be  obtained,  tie  legs  and  thighs  together. 

Broken  Knee-cap 

Symptoms. — As  above,  patient  falls  to  ground  and  cannot 
raise  leg.  Not  difficult  to  detect  fracture,  as  can  feel  groove  in 
knee-cap  immediately  beneath  the  skin. 

Treatment. — Services  of  a  physician  will  be  required  and  shock 
generally  demands  treatment.  Must  also  use  care  in  moving 
leg. 

Straighten  leg.  Secure  splint  long  enough  to  extend  from 
middle  of  thigh  to  middle  of  lower  leg.  Preferably,  this  should 
be  a  thin  board  as  wide  as  thigh,  but  a  cane,  umbrella  or  the 
like  may  be  used  in  case  of  emergency.  Make  pad  for  splint, 
apply  splint  to  back  of  thigh  and  leg  with  middle  opposite  bend 
of  knee  and  tie  in  place  with  strips  of  cloth  or  handkerchiefs. 
Be  careful  not  to  put  bandage  over  break,  but  one  strip  im- 
mediately above  andone  immediately  below  knee. 

Fracture  of  Collar-bone 

Symptoms. — Patient  supports  elbow  of  injured  side  with  hand 
of  other  side.  Is  unable  to  raise  arm  above  shoulder.  Is  easy 
to  feel  depression  by  running  finger  over  injured  collar-bone. 

Treatment. — Send  for  doctor.     Treat  shock. 

Make  pad  from  a  large  handkerchief,  two  medium-sized 
handkerchiefs,  a  triangular  bandage  or  the  like.  Place  this  pad 
in  arm-pit  of  injured  side.  Put  arm  in  sling  with  forearm  at 
right  angle  to  upper  arm. 


42        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 


First    Aid    Dressing   Applied 
Around  Body  for  Broken  Rib. 


3.  Blanket  Splint 
for  Leg 


2.  First  Aid  Bandage  Around  Hips 
for  Broken  Pelvis. 


4.  Improvised 
Splint  for 
Leg 


5.  Improvised  Splint  for  Arm. 


James  FBrerrer 


Plate  VIII. — Fractures. 


FRACTURE    OF   LOWER  JAW  43 

Take  a  bandage  about  3  inches  wide,  put  this  horizontally 
around  body  and  injured  arm  at  elbow.  It  will,  of  course,  en- 
circle both  the  elbow,  the  bent  arm  and  the  body.  When  tied. 
by  pulling  elbow  to  body  it  will  force  upper  end  of  humerus 
outward,  and  thus  prevent  broken  ends  of  collar-bone  from 
overlapping. 

Another  method: 

Have  patient  lie  down  and  place  his  injured  shoulder  on  pillow 
in  a  comfortable  position  till  doctor  arrives. 

Fracture  of  Ribs 

Symptoms. — Sharp  pain  on  taking  a  long  breath  or  coughing. 
Breathing  is  usually  short,  patient  often  presses  hand  to  side  to 
prevent  movement  of  chest. 

May  feel  grating  of  ends  of  broken  bones  on  each  other  by 
placing  hand  on  chest  at  point  where  pain  is  most  severe. 

Treatment. — Tie  a  large  handkerchief  or  a  triangular  bandage 
firmly  around  the  chest,  pin  a  large  towel  snugly  around  chest 
or  best  apply  a  roller  bandage  to  chest.  These  limit  chest  motion 
and  thus  diminish  pain. 

If  shock  is  severe,  call  doctor  immediately.  If  not,  after 
bandage  is  in  place  may  visit  a  doctor  as  soon  as  practicable. 
Treat  shock. 

Fracture  of  Skull 

Symptoms. — Patient  is  probably  unconscious  from  injury  to 
brain.  If  at  base  of  skull,  there  will  probably  be  a  discharge 
of  blood  from  nose,  ears  or  mouth.  If  at  top  of  skull,  fracture 
may  easily  be  felt. under  skin. 

Treatment. — Send  for  doctor.  Place  in  lying-down  position 
with  head  slightly  raised  and  keep  very  quiet  until  doctor  arrives. 
Treat  shock  but  no  stimulants  unless  patient  is  very  weak. 

Fracture  of  Lower  Jaw 

Symptoms. — Mouth  open,  patient  cannot  speak.  Fracture 
may  often  be  felt  outside,  and  inside  there  will  be  an  irregularity 
of  the  teeth.     May  be  bleeding  from  gums.     Shock. 


44        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN     , 

Treatment. — Send  for  doctor.    Treat  shock. 

Gently  raise  broken  jaw  and  bring  lower  against  upper  teeth. 
Support  in  this  position  with  the  jaw  bandage  or  with  two 
strips  of  bandage,  one  vertical,  tied  over  top  of  head  and  the 
other  longer,  brought  to  back  of  head,  crossed  and  brought 
horizontally  to  forehead  and  tied  there. 

Broken  Back 

Symptoms. — Patient  unable  to  move.  No  motion  or  feeling 
in  body  below  injury. 

Treatment. — Send  for  doctor  at  once.  If  possible,  do  not 
move  patient  before  his  arrival.     Treat  shock. 

If  patient  must  be  taken  from  the  spot  where  his  injury  has 
occurred,  procure  ample  assistance  to  lift  him.  This  should 
be  done  with  the  greatest  care  so  as  not  to  bend  spine  for  this 
will  crush  spinal  cord. 

Put  stretcher  under  patient  and  gently  lower  him  to  stretcher. 

Fracture  of  Nose 

Symptoms. — Usually  not  difficult  to  detect.  Pain,  swelling, 
crepitus  and  deformity.  Swelling  may  be  so  great  that  obscures 
deformity.     Is  not  infrequently  compound. 

Treatment. — Put  in  as  natural  position  as  possible  and  hold 
there  with  an  adhesive-plaster  strip  across  nose  from  cheek  to 
cheek.  Before  applying  plaster,  put  a  small  compress  of  gauze 
on  each  side  of  nose.  If  you  have  no  adhesive  plaster  put  on 
bandage  over  nose  and  around  head,  but  do  not  pull  tight  enough 
to  flatten  nose.  Consult  doctor,  as  there  is  danger  of  permanent 
deformity. 

QUESTIONS 

i.  What  are  the  common  injuries  without  a  break  in  the  skin? 

2.  How  may  such  injuries  be  prevented? 

3.  Of  what  is  the  body  composed? 


QUESTIONS  45 

4.  What  is  the  skeleton  and  what  does  it  do  as  a  part  of  the  body? 

5.  Of  what  parts  is  the  head  made  up? 

6.  Into  what  two  parts  is  the  trunk  divided  and  what  does  each 
contain? 

7.  Describe  the  spinal  column;  the  ribs;  the  breast-bone;  and  the 
pelvis. 

8.  Of  what  bones  is  the  upper  limb  formed?     The  lower  limb? 

9.  What  is  a  joint? 

10.  What  movements  do  joints  have?     Give  an  example  of  a  ball- 
and-socket  and  of  a  hinge  joint. 

11.  What  are  the  muscles? 

12.  What  is  the  purpose  of  the  muscles? 

13.  What  is  the  importance  of  muscles  in  reference  to  fractures  and 
dislocations? 

14.  What  is  the  subcutaneous  tissue? 

15.  Describe  bruises. 

16.  What  are  the  symptoms  of  bruises? 

17.  How  would  you  treat  them? 

18.  In  a  severe  bruise  what  else  must  you  look  out  for? 

19.  What  is  a  strain?     How  is  it  caused?     What  are  the  symptoms? 

20.  What  is  the  treatment? 

2i.  What  is  a  sprain?     How  is  it  caused?     Symptoms?     Treat- 
ment? 

22.  Is  a  severe  sprain  a  slight  injury? 

23.  What  is  a  dislocation? 

24.  How  are  dislocations  caused?     Symptoms?     Treatment? 

25.  Under  what  circumstances  would  you  be  justified  in  tryir"  to 
reduce  a  dislocation? 

26.  When  should  you  proceed  to  do  so? 

27.  Danger  of  attempts  to  reduce  dislocation? 

28.  Describe  special  treatment  for  dislocations  of  the  lower  jaw, 
finger  and  shoulder. 

29.  What  is  fracture? 

30.  What  is  a  simple  fracture? 

31.  What  is  a  compound  fracture?     Causes  of  simple  fractures  and 
of  compound  fractures? 

32.  How  would  you  prevent  a  simple  fracture  from  becoming  a 
compound  one? 

33.  How  would  you  recognize  a  simple  fracture? 

34.  How  would  you  treat  a  simple  fracture? 

35.  How  would  you  recognize  a  compound  fracture? 


46        INJURIES  IN  WHICH  THE  SKIN  IS  NOT  PIERCED  OR  BROKEN 

36.  Treatment  of  compound  fracture? 

37.  What  is  a  splint? 

3&.  From  what  materials  may  a  splint  be  made? 

39.  Precautions  in  applying  splints? 

40.  Symptoms  and  treatment  of  fracture  of  the  upper  arm  and  fore- 
arm; of  wrist;  of  fingers;  crushed  hand — foot;  of  the  lower  leg;  the  thigh; 
of  knee-cap;  of  collar-bone;  of  ribs;  of  skull;  of  lower  jaw;  of  back; 
of  nose. 

PRACTICAL  EXERCISES 

Show  methods  of  treatment  of  dislocations  of  lower  jaw,  shoulder  and 
fingers. 

Show  methods  of  treatment  of  a  simple  fracture. 

Show  application  of  splints  in  fracture  of  upper  arm  and  forearm: 
wrist;  fingers;  crushed  hand  and  foot;  fracture  of  lower  leg;  the  thigh: 
the  knee-cap;  collar-bone;  ribs;  skull;  lower  jaw;  back;  nose. 

Practise  in  bandaging  and  the  application  of  splints. 


CHAPTER  IV 

INJURIES  IN  WHICH  THE  SKIN  IS  PIERCED  OR  BROKEN : 
WOUNDS 

Injuries  in  which  the  skin  is  pierced  or  broken  are  called 
wounds.  As  will  be  seen,  such  injuries  have  certain  dangers 
that  other  injuries  are  free  from.  In  order  to  understand  them 
it  is  necessary  for  the  first-aid  student  to  know  of  the  protection 
afforded  the  body  by  the  skin  and  of  the  action  of  certain  germs 
on  the  body. 

The  Skin 

Of  course,  everybody  knows  what  the  skin  is.  It  is  the  cover- 
ing of  the  entire  body.  The  skin  is  made  up  of  different  layers. 
The  outside  horny  layer  protects  the  body  from  the  entrance 
of  pus  germs  which  are  the  very  small  parasites  which  cause 
inflammation,  matter  or  pus  and  blood  poisoning.  Remember 
that  these  pus  germs  always  come  from  outside  the  body  and  if 
the  skin  is  unbroken  they  cannot  enter  it.  In  consequence  any 
injury  in  which  there  is  a  break  in  the  skin  is  liable  to  the  addi- 
tional, and  perhaps  very  great  danger  due  to  pus  germs. 

The  Germs 

:  The  action  of  pus  germs  on  the  body  is  very  important.  The 
wonderful  operations  which  modern  surgeons  are  able  to  perform 
are  entirely  due  to  their  knowledge  of  how  to  protect  the  body 
from  the  injurious  effects  of  these  germs. 

With  an  injury  of  the  body  from  a  mechanical  or  chemical 
cause  the  effect  of  the  injury  appears  at  once.  With  germs  this 
is  different,  however.     Everything  looks  all  right  at  first  and  the 

47 


4&        INJURIES    IN    WHICH   THE    SKIN   IS   PIERCED    OR  BROKEN 


BLOOD  POISONING  AND  MATTER  OR  PUS 


1.  Normal  Section  of  Skin 
(magnified) 


2.  Showing  Clean-cut  Wound  3.  Wound  Caused  by  a 

Caused  by  a  Sharp  Instrument  Blunt  Instrument 


4.  Infection  by  Handling,  or  Water 


5.  How  to  Care  For  a  Wound 
A   Clean    Dressing 


Plate  IX. 


DESCRIPTION  OF  PLATE  IX. 

I.     NORMAL   SECTION    OF   SKIN. 

(Magnified.) 
Note  the  upper  horny  layer.     This  protects  the  body  from  the  en- 
trance of  pus  germs  which  are  the  very  small  parasites  which  cause 
inflammation,  matter  or  pus  or  blood  poisoning. 

2.  WOUND   CAUSED  BY  A   SHARP   INSTRUMENT. 

In  a  wound  caused  by  a  sharp  instrument,  while  the  protection  of 
the  skin  is  lost,  comparatively  few  germs  are  carried  into  the  wound. 
Most  of  these  are  washed  out  by  the  blood.  The  very  slightly  in- 
jured cells  of  the  body  are  able  to  destroy  many  others.  So  such 
wounds  are  not  as  dangerous  as  ragged,  torn  wounds.  No  germs 
float  in  the  air  and  there  is  no  danger  in  exposing  wounds  to  the  air. 

3.  WOUND  CAUSED  BY  A  BLUNT  INSTRUMENT. 

With  a  blunt  instrument  many  more  germs  are  driven  in.  The 
bruising  of  the  tissues  of  the  body  makes  the  cells  much  less  able  to 
destroy  the  germs  and  bleeding  is  not  so  free.  So  such  wounds  are 
much  more  likely  to  be  followed  by  inflammation  and  the  formation 
of  pus  or  matter  than  are  clean  cuts.  (Note.  The  germs  have  not; 
been  carried  to  the  deeper  parts  of  the  wound.) 

4.     INFECTION  BY  HANDLING   OR  WATER. 

If  the  wound  is  touched  by  the  hand  billions  of  pus  germs  will  be 
carried  into  it.  If  washed  with  water  even  more  germs  will  be  carried 
into  the  wound  and  not  only  that,  but  the  deep  parts  of  the  wound 
which  previously  no  germs  had  reached  will  have  billions  of  germs 
carried  to  them.  Therefore  do  not  handle  or  wash  a  wound.  Even 
if  an  antiseptic  solution  is  used  it  will  carry  pus  germs  from  the  skin  and 
deeper  than  they  have  been  before  and  no  antiseptic  such  as  bichlo- 
ride of  mercury  can  be  used  strong  enough  to  kill  these  germs,  as  it 
will  then  also  destroy  the  cells  of  the  body  and  so  make  them  less  able 
to  fight  the  germs.  Peroxide  is  specially  dangerous  in  deep  wounds 
as  it  carries  pus  germs  everywhere  and  is  not  strong  enough  to  destroy 
them. 

5.     HOW  TO   CARE   FOR  A   WOUND. 

Placing  a  clean  dressing,  which  means  a  dressing  that  has  been 
sterilized  surgically  (such  as  the  Red  Cross  Dressing)  on  the  wound 
will  introduce  no  more  germs  and  will  not  injure  the  delicate  tissues  of 
the  body,  exposed  in  the  wound.  Moreover,  the  flow  of  blood  and 
blood  serum  (the  liquid  part  of  the  blood)  will  be  in  the  direction  of 
the  dressing,  so  the  germs  will  be  constantly  going  out. 

This  therefore,  is  the  way  to  take  care  of  a  wound. 

4  49 


50        INJURIES   IN   WHICH   THE    SKIN   IS   PIERCED    OR  BROKEN 

bad  effects  only  appear  later  with  the  growth  of  the  germs  and 
the  production  of  their  powerful  poisons. 

These  germs  are  so  small  that  they  can  only  be  seen  through  a 
powerful  microscope.  What  they  lack  in  size  they  make  up  in 
numbers  and  they  live  outside  of  the  body  in  countless  millions. 
They  do  not  float  around  in  the  air,  so  there  is  no  danger  from 
them  in  exposing  a  wound  to  the  air.  Pus  germs  are  found  on 
the  surface  of  our  bodies,  on  knives  and  other  objects  which  cause 
wounds,  in  the  dust  of  houses,  in  water,  and  also  on  surgical 
instruments  and  dressings  unless  special  means  have  been  taken 
to  free  them  of  germs  or,  in  other  words,  unless  they  have  been 
disinfected  or  sterilized. 

The  Wound 

Suppose  a  wound  is  received,  what  happens?  If  pus  germs  do 
not  gain  entrance  to  it,  there  will  be  no  inflammation  and  it  will 
heal  quickly  and  kindly;  but  if,  on  the  other  hand,  the  wound  is 
infected  by  pus  germs,  this  means  that  inflammation  will  follow, 
more  or  less  matter  will  form,  and  there  will  be  some  absorption 
of  poison  from  the  wound  which  may  result  in  the  more  severe 
forms  of  blood-poisoning  and  almost  inevitable  death.  But  as 
pus  germs  are  so  generally  present,  it  might  appear  that  under 
ordinary  conditions  they  would  always  be  carried  into  a  wound 
when  it  is  received,  either  from  the  surface  of  the  body  or  by 
the  object  which  caused  the  wound.  This  is  true,  but  if  only  a 
few  pus  germs  are  so  carried  into  the  body  certain  cells  there  will 
dispose  of  the  germs  without  trouble  and  no  harm  will  result; 
moreover,  unless  too  many  pus  germs  are  carried  into  the  body, 
the  blood  resulting  from  the  injury  will  often  wash  so  many  out 
that  the  cells  can  dispose  of  the  few  left  with  little  difficulty. 
This  is  exactly  the  reason  why  a  wound  which  bleeds  freely  is 
less  likely  to  prove  dangerous.  We  should  conclude,  then,  that 
every  wound  is  not  infected  with  pus  germs  and  must  use  every 
care  not  to  infect  it  by  our  hands,  by  water,  dressings  or  anything 
else. 

The  symptoms  of  inflammation  in  a  wound  are  heat,  redness, 


VARIETIES    OF   WOUNDS  CI 

pain,  swelling  and  partial  or  complete  loss  of  use  of  the  wounded 
part.  These  are  the  signs  of  wound  infection  and  if  these  appear 
in  a  wound  three  or  four  days  after  an  injury,  unless  they  are 
slight  a  doctor  is  necessary,  as  they  may  grow  much  worse. 

While  the  breaking  or  piercing  of  the  skin  is  what  distinguishes 
wounds  from  other  injuries,  in  wounds  there  is  also,  of  course, 
more  or  less  damage  to  the  parts  of  the  body  beneath  the  skin. 
As  blood-vessels  are  found  practically  everywhere  in  the  body 
they  are  always  injured  in  a  wound  and  some  bleeding  results. 
Usually — in  about  ninety-nine  cases  out  of  a  hundred — this 
bleeding  is  not  severe  and  may  be  checked  by  the  pressure  of  an 
ordinary  wound  dressing.  In  nearly  all  wounds  therefore  what 
we  must  specially  look  out  for  is  to  prevent  germs  getting  in. 

Varieties  of  Wounds. — i.  Cut  or  incised  wounds,  in  which 
the  skin  and  underlying  tissues  are  cleanly  divided  by  a  sharp 
instrument.  They  are  caused  by  razors,  sharp  knives,  glass  and 
the  like.  In  this  variety  of  wounds,  as  blood-vessels  are  cleanly 
cut  across,  there  is  likely  to  be  severe  bleeding. 

2.  Torn  or  lacerated  wounds,  in  which  the  tissues  are  torn 
rather  than  cut.  They  are  caused  by  a  tearing  or  crushing 
injury,  such  as  the  blow  of  a  blunt  instrument,  by  machinery 
or  by  being  run  over  or  struck  by  a  wagon,  trolley  or  railway 
car.  With  them,  as  the  blood-vessels  are  crushed  as  well  as  the 
other  tissues,  severe  bleeding  is  not  nearly  so  likely  to  occur  as 
in  the  preceding  variety,  but  on  account  of  the  character  of  the 
injury,  dirt  is  likely  to  be  ground  into  the  tissues  and  they  are 
so  extensively  torn  and  destroyed  that  infection  followed  by 
inflammation  and  matter  or  pus  is  extremely  common. 

3.  Punctured  wounds  are  deep  wounds  of  small  size  produced 
by  sharp-pointed  instruments,  such  as  daggers,  bayonets  and 
the  like.  Wounds  caused  by  bullets  are  also  included  in  this 
class.  Wounds  of  this  variety  are,  of  course,  frequently  pur- 
posely inflicted,  but  the  great  majority  of  bullet  wounds  in  civil 
life  result  from  carelessness  which  is  almost,  if  not  quite,  criminal. 
"I  didn't  know  it  was  loaded"  is  not  sufficient  excuse  for  shooting 
a  fellow-being,  and  if  one  observes  the  rule  of  never  point- 
ing a  gun  or  pistol  at  himself  or  at  anyone  else  he,  will  have 


52        INJURIES   IN   WHICH   THE   SKIN  IS   PIERCED    OR  BROKEN 

no  occasion  to  make  this  excuse.  The  amount  of  bleeding  in 
this  variety  of  wounds  is  often  slight,  but  may  be  great  if  a  large 
blood-vessel  is  injured.  Infection  is  not  uncommon,  as  pus 
organisms  when  carried  into  such  wounds  are  best  situated  to 
increase  in  numbers. 

Symptoms  of  Wounds. — The  wound  itself.  Pain.  Bleeding. 
Shock. 

Treatment  of  Ordinary  Wounds. — (This  refers  to  the  vast 
majority  of  wounds  in  which  as  previously  noted  bleeding  is 
slight.  For  the  treatment  of  severe  bleeding  see  next  chapter.) 
In  deep  wounds  or  those  which  cover  a  considerable  surface, 
always  send  for  a  doctor  at  once.  It  is  always  better  to  call  in 
a  physician  if  you  doubt  your  ability  or  resources.  Treat  shock. 
In  all  wounds  if  necessary  cut  or  rip  clothing  so  as  to  get  a  view 
of  the  wound.  Turn  back  the  clothing  so  it  does  not  touch 
wound.  Do  not  touch  wound  yourself  nor  allow  the  wounded 
person  to  touch  it.  Remember  there  is  no  hurry,  for  air  will  not 
infect  the  wound.  If  a  physician  may  be  expected  to  arrive 
within  a  few  moments,  it  will  usually  be  necessary  to  do  nothing 
further.  Exposure  to  the  air  is  much  safer  than  the  application 
of  anything  which  is  not  surgically  clean  or  antiseptic.  If, 
however,  you  have  a  surgically  clean  or  antiseptic  wound  dress- 
ing, apply  it  to  the  wound  at  once  and  bandage  firmly  into  place. 
This  will  prevent  accidental  contamination  and  will  usually 
stop  any  bleeding  there  may  be. 

Water  is  dangerous  as  it  contains  many  pus  germs.  Strong 
antiseptics  such  as  bichloride  of  mercury  or  carbolic  acid  will 
destroy  the  cells  of  the  body  which  dispose  of  the  pus  germs  be- 
fore they  kill  the  latter  and  should  never  be  used.  Peroxide  of 
hydrogen  is  not  strong  enough  to  kill  germs  and  in  a  large  or 
deep  wound  it  washes  them  to  uninfected  parts  which  then  be- 
come infected.  Therefore,  use  none  of  these  things  but  cover 
the  wound  to  keep  out  pus  germs. 

What  has  been  said  applies  to  all  kinds  of  wounds  and  the  treat- 
ment given  is  a  good  one  for  the  little  cuts  or  scratches  which  are 
so  common.  But  these,  especially  if  they  do  not  go  through  the 
skin,  are  rarely  dangerous.    We  do  hear  from  time  to  time  of 


WOUND   DRESSINGS  53 

some  one  dying  from  blood-poisoning  as  the  result  of  the  scratch 
of  a  pin  but  many  thousand  such  slight  injuries  are  received 
which  are  recovered  from  with  or  without  treatment.  Inflam- 
mation of  these  slight  wounds  is  not  particularly  uncommon, 
however,  and  this  should  be  prevented  if  possible.  They  rarely 
bleed  much  and  making  them  bleed  so  that  the  blood  will  wash 
out  the  germs  is  the  best  thing  to  do  first.  Do  not  suck  them  as 
very  dangerous  pus  germs  are  found  in  the  mouth.  Squeeze 
them  well  at  the  sides.  With  a  finger  it  is  well  to  encircle  the 
finger  near  the  hand  with  the  thumb  and  finger  of  the  other  hand 
and  then  to  work  down  with  strong  pressure,  pushing  all  the 
blood  in  the  finger  ahead  of  the  encircling  thumb  and  finger  of 
your  other  hand.  This  is  sometimes  called  milking  the  finger. 
After  the  blood  has  been  squeezed  out  a  piece  of  clean  gauze 
makes  an  excellent  dressing.  These  small  wounds  may  be  safely 
washed  with  peroxide  before  a  dressing  is  put  on  as  with  them 
there  is  no  danger  of  pus  germs  being  washed  into  deep  parts. 
Collodion  may  safely  be  used  on  a  shallow,  cleanly  cut  wound  but 
if  the  wound  becomes  inflamed  it  must  be  removed  as  this  shows 
pus  germs  have  been  sealed  up  and  are  multiplying  and  produc- 
ing poison.  The  use  of  plaster  (except  court  plaster  to  cover  a 
trivial  scrape  not  involving  the  entire  thickness  of  the  skin) 
must  be  absolutely  condemned,  for  not  only  does  plaster  seal 
the  wound  so  any  germs  within  will  be  in  most  favorable  posi- 
tion to  increase  in  numbers  but  is  itself  likely  to  be  covered  with 
pus  germs. 

More  about  Wound  Dressings. — A  wound  dressing  consists 
of  everything  which  is  used  to  cover  or  to  dress  a  wound.  The 
pad  which  is  put  directly  on  the  wound  is  called  a  compress. 
In  ordinary  emergency  treatment  a  bandage  is  put  on  immedi- 
ately over  the  compress  and  this  is  all  that  is  necessary.  With 
much  bleeding  it  is  better,  if  you  have  it,  to  put  a  layer  of  absor- 
bent cotton  over  the  compress  and  then  to  bandage.  It  is 
important  that  the  compress  should  not  only  be  large  enough  to 
cover  the  wound  but  to  lap  an  inch  or  so  on  each  side.  Do  not 
forget  that  the  compress  is  the  most  important  part  of  the  dress- 
ing.    It  is  the  inside  we  are  looking  after,  not  the  outside  and  a 


54        INJURIES    IN   WHICH   THE    SKIN   IS   PIERCED    OR   BROKEN 

beautifully  applied  bandage  will  not  make  up  for  a  dirty  or 
poorly  applied  compress. 

Surgeons  commonly  say  dressing  materials  are  clean  or  dirty. 
They  mean  surgically  clean  for  the  former,  that  is  to  say,  the 
germs  in  them  have  been  killed  by  some  means.  Every  material 
is  dirty  in  the  surgical  sense  if  the  germs  have  not  been  killed. 
Surgically  clean,  sterile,  or  antiseptic  dressings  as  they  are  vari- 
ously called  are,  of  course,  the  only  kind  that  should  be  applied  to 
wounds. 

Most  things  required  by  the  first-aider  can  be  made.  As  will 
be  seen,  however,  the  process  of  making  good  wound  compresses 
is  complicated  and  it  is  much  safer  to  have  such  articles  ready 
at  hand. 

Of  course  it  not  only  is  necessary  that  the  germs  be  killed  at 
the  time  a  wound  compress  is  made  but  when  it  is  put  on  the 
wound  that  it  has  not  been  contaminated  in  the  meantime  and 
that  it  can  be  handled  at  that  time  without  being  contaminated. 

The  necessity  for  a  safe  dressing  for  wounds  led  to  the  making 
of  the  American  Red  Cross  First-aid  Outfits. 

In  each  of  these  outfits  is  found  a  long  gauze  bandage  with  a 
compress  of  gauze  sewn  to  it  in  the  center,  a  triangular  bandage 
printed  so  as  to  show  how  to  apply  it,  and  two  safety-pins. 

The  directions,  which  are  also  found  inside  the  case,  are  as 
follows: 

'  Gauze  Bandage  with  Compress. — If  there  is  a  wound  or  any 
injury  in  which  the  skin  is  broken,  this  bandage  and  compress 
are  used  by  unfolding  the  bandage,  being  careful  not  to  touch  the 
inner  surface  of  the  compress.  The  compress  should  then  be 
placed  directly  on  the  wound  or  injury,  and  held  in  place  by  wrap- 
ping the  ends  of  the  bandage  around  the  limb  in  opposite  direc- 
tions and  tying  them  or  pinning  them  in  place.  With  a  very 
large  wound  which  the  compress  will  not  cover,  apply  it  to  the 
middle  of  the  wound  and  wrap  the  bandage  around  as  before. 
In  this  case  be  careful  not  to  touch  any  surface  of  the  bandage 
which  is  placed  on  the  wound.  In  case  there  is  no  wound,  this 
bandage  may  be  used  like  an  ordinary  bandage  to  hold  splints 
in  place,  etc. 


WOUND    DRESSINGS 


55 


1.  The  Dressing  js  Free  from  Germv  The 
operator  u  careful  nol  to  touch  the  surface 
which  will  cover  the  wound 


6.  How  to  Dress  a  Wound 


NOTE.  This  Dressing  U 
hermetically  sealed  and  is 
protected  from  any  acci- 
dental contamination  be- 
fore being  used,  so  that  you 
KNOW  it  it  safe  to  put  on 


7.  Red  Cross  First-Aid  Outfit 


A  Compress  U  Sewed  b  the  middle  of  a 
bandage  which  is  to  folded  that  it  U  im- 
to  touch  the  surface  of  the  compress 
which  will  cover  the  wound  except  through 

gross  < 


9.  How  to  Apply  Red  Cross   Compress 


Plate  X. — Surgical  dressings. 


56        INJURIES   IN  WHICH   THE   SKIN  IS   PIERCED    OR  BROKEN 

"  Triangular  Bandage. — The  triangular  bandage  may  be  used 
as  an  outer  bandage  or  as  a  sling  in  the  manner  pictured  on  it. 
This  bandage  should  also  be  tied  or  pinned  in  place. 

"Do  not  touch  an  open  wound  with  the  fingers,  water,  or  any- 
thing except  the  compress,  or  when  very  large  the  untouched 
surface  of  the  bandage. 

"The  pressure  of  the  bandage  will  stop  ordinary  bleeding." 

The  advantages  of  this  outfit  are  that  the  contents  are  always 
clean  and  ready  for  use,  the  dressing  may  be  easily  applied,  and 
not  only  does  it  contain  a  dressing,  but  also  a  sling.  With  it 
and  materials  for  splints  which  may  usually  be  easily  obtained 
you  are  ready  for  any  ordinary  injury. 

A  number  of  other  first-aid  packets  are  on  the  market  which 
contain  compresses  that  may  be  safely  applied  to  a  wound, 
though  none  is  quite  so  easy  to  handle  without  accidental  con- 
tamination as  the  Red  Cross  outfit.  Each  has  printed  directions 
on  the  box  or  container  which  must  be  carefully  followed. 

If  a  first-aid  packet  can  be  procured  it  should  always  be  used 
in  preference  to  anything  else  to  dress  a  wound.  The  next 
choice  should  be  sterile  or  antiseptic  gauze.  Small  packages  of 
such  gauze  suitable  for  compresses  may  be  bought  in  most  drug 
stores,  and  are  found  in  emergency  cases.  (Sterile  gauze  is 
ordinary  gauze  in  which  the  germs  have  been  destroyed  by  heat, 
and  antiseptic  gauze  is  ordinary  gauze  in  which  germs  have  been 
destroyed  by  an  antiseptic,  usually  bichloride  of  mercury.)  In 
a  city,  therefore,  or  if  an  emergency  case  is  available,  one  may 
easily  procure  a  safe  compress  and  all  he  need  do  is  to  handle  it 
sc  that  he  will  not  contaminate  it.  This  may  be  accomplished 
by  holding  it  not  with  the  fingers,  but  by  the  paper  which  covers 
it,  allowing  only  the  inner  surface  of  this  paper  to  come  in  contact 
with  the  gauze  and  never  removing  part  of  the  paper  until  it  has 
served  this  purpose.  If,  by  chance,  the  gauze  is  touched  by  the 
hand  great  care  should  be  taken  to  drop  the  untouched  part  on 
the  wound  and  to  place  the  gauze  which  has  come  in  contact 
with  the  hand  as  near  the  outer  layer  of  the  compress  as  possible. 

As  stated,  unless  a  safe  gauze  can  be  procured  it  is  much  safer 
to  leave  a  wound  exposed  to  the  air  than  to  cover  it,  but  this  will 


WOUND   DRESSINGS  57 

not  always  prove  practical.  It  is  especially  in  places  where 
no  gauze  for  compresses  can  be  procured  that  circumstances 
render  it  necessary  to  cover  wounds.  In  such  localities  it  may 
be  hours  before  the  services  of  a  doctor  can  be  procured,  so  an 
uncovered  wound  will  be  exposed  for  a  long  time  to  accidental 
contamination,  which  will  be  almost  inevitable  from  the  hands 
or  clothing  of  the  injured  person  who  must  perhaps  be  moved. 
A  compress,  too,  affords  an  excellent  means  of  checking  bleeding, 
being  often  all  that  is  required  for  this  purpose. 

Under  such  circumstances,  therefore,  it  will  be  necessary  to 
make  a  compress  which,  if  not  as  safe  as  is  desirable,  is,  at  least, 
as  good  as  can  be  procured.  First,  as  surgically  clean  cloth  for 
the  compress  as  can  be  obtained  should  be  used.  This  will  be 
found  in  a  towel,  a  handkerchief  or  other  cloth  of  the  same  kind 
which  has  recently  been  laundered  and  has  not  been  used  since 
it  was  washed.  Preferably,  this  cloth  should  be  boiled  for  ten 
minutes  or  soaked  in  a  solution  of  i-iooo  bichloride  of  mercury, 
corrosive  sublimate,  for  an  equal  length  of  time.  (Tablets  of 
corrosive  sublimate  are  in  common  use;  they  are  known  as  anti- 
septic tablets.  This  substance  is  a  deadly  poison  and  its  solu- 
tion cannot  be  made  in  metal  vessels.)  The  process  recom- 
mended will  give  a  compress  which  is  safe  to  use,  but  an  impor- 
tant practical  difficulty  is  presented  in  applying  such  a  compress 
to  a  wound.  It  will,  of  course,  be  so  wet  that  it  will  not  be 
possible  to  put  it  on  the  wound  without  squeezing  some  of  the 
water  out  of  it.  To  do  this  the  compress  must  necessarily  be 
handled  and,  as  has  been  explained,  pus  germs  exist  in  countless 
millions  on  the  hands. 

If  possible,  the  hands  must  be  cleaned  surgically,  which  means 
they  should  be  freed  of  germs.  This  should  be  done  by  hard 
scrubbing  for  five  minutes  with  hot  water,  soap  and  a  nail- 
brush, paying  special  attention  to  the  nails.  Preferably  the 
hands  should  be  washed  under  a  tap  instead  of  in  a  basin,  and 
if  a  basin  is  used  the  water  had  best  be  changed  two  or  three 
times.  As  a  further  precaution,  when  corrosive  sublimate  is 
procurable,  the  hands  after  being  washed  should  be  soaked  in  a 
1-1000  solution  of  that  chemical  for  a  period  of  five  minutes. 


5&        INJURIES   IN   WHICH  THE   SKIN  IS  PIERCED   OR  BROKEN 

The  hands  must  not  be  wiped  and  they  must  not  touch  anything 
except  the  compress.  The  piece  of  cloth  which  is  intended  for 
a  compress  may  now  be  taken  from  the  vessel  in  which  it  has  been 
boiled  or  disinfected,  but  in  so  doing  the  operator  should  be 
very  careful  not  to  allow  his  hands  to  touch  that  part  of  the  com- 
press which  he  intends  to  put  on  the  wound.  On  the  contrary, 
he  should  pick  up  the  piece  of  cloth  by  its  outer  surface  and, 
holding  it  at  all  times  by  this,  squeeze  the  water  from  it  until  it 
is  comparatively  dry  and  then  put  it  on  the  wound  without 
delay.  If  a  fairly  large  piece  is  taken  for  the  compress  and  if, 
previous  to  boiling,  or  disinfection,  it  is  folded  so  as  to  fit  the 
wound  it  will  be  handled  much  more  easily  and  safely. 

When  no  facilities  are  available  for  washing  and  disinfecting 
the  hands,  this  naturally  must  be  omitted,  but  the  same  precau- 
tions should  be  taken  in  handling  the  compress.  Suppose,  how- 
ever, that  in  addition  the  compress  cannot  be  boiled  or  disin- 
fected, and  yet  it  is  absolutely  necessary  to  have  one.  In  this 
case  one  should  again  take  a  towel,  handkerchief,  etc.,  which 
has  just  been  laundered,  and  without  unnecessary  handling 
apply  its  inner  surface  to  the  wound.  Towels,  handkerchiefs, 
etc.,  which  have  been  used  or  handled,  though  they  may  look 
clean,  are  never  so  in  the  surgical  sense  and  are  therefore  particu- 
larly dangerous  to  use  as  compresses. 

Special  Wounds 

Abdominal  Wounds. — All  wounds  should  be  treated  on  the  gen- 
eral principles  already  described.  A  word  or  two  is  required, 
however,  on  the  subject  of  abdominal  wounds  in  which  more  or 
less  of  the  abdominal  contents  escape  through  a  large  cut. 
Send  for  a  doctor  at  once.  Place  a  clean  cloth  over  the  wound 
and  keep  it  constantly  wet  with  a  weak  solution  of  salt  and  water, 
for  if  these  delicate  structures  become  dry  they  will  suffer  almost 
fatal  damage  from  this  cause  alone.  Boiled  water  is  the  only 
safe  water  to  use  for  this  purpose  but  if  you  cannot  boil  the  water 
you  will  have  to  use  the  cleanest  water  available.    Treat  shock. 

Wounds  in  which  Foreign  Bodies  Remain.  Treatment. — 
Such  bodies  should  be  gently  pulled  from  the  wound  in  a  direc- 


EYE   WOUNDS  59 

tion  contrary  to  that  in  which  they  entered.     If  they  are  of 

considerable  size  and  have  damaged  the  tissues  a  good  deal,  thev 

wound  should  be  shown  to  a  doctor  at  the  earliest  opportunity. 

With  a  splinter  of  wood,  the  commonest  of  such  foreign  bodies: 

Pull  the  splinter  from  the  wound  with  a  pair  of  pincers 

or  by  putting  a  knife  blade  against  it  and  holding  it  on  the 

blade  with  the  thumb-nail. 

The  same  method  may  be  used  with  a  splinter  under  the 
nail.  But  if  it  is  broken  under  the  nail,  scrape  the  nail  thin 
over  it  and  cut  out  a  small  V-shaped  piece  so  as  to  reach  it. 
Small  splinters  in  the  skin  may  be  removed  by  a  needle. 
In  order  to  avoid  possible  infection  it  will  be  much  safer 
to  wash  the  skin  with  hot  water  and  soap  and  to  pass  the 
needle  through  a  flame  before  using  it. 
A  wound  from  which  a  foreign  body  has  been  removed  should 
never  be  sealed  with  plaster  or  collodion. 

Eye  Wounds,  Including  Foreign  Bodies  in  the  Eye. — The 
eye  is  the  organ  of  sight.  It  is  a  ball  surrounded  by  three  coats. 
Covering  the  eyeball  in  front  is  a  delicate  membrane  called  the 
conjunctiva.  Protection  to  this  membrane  is  afforded  by  the 
eyelids  when  they  are  closed,  but  when  they  are  open  it  is  very 
liable  to  injury  and  to  the  entrance  of  foreign  bodies.  These 
are  commonly  spoken  of  as  "  something  in  the  eye."  On  account 
of  the  sensitiveness  of  the  conjunctiva,  they  cause  much  pain  and 
distress.  The  eyeball  itself  is  well  protected  from  injury,  as 
it  is  situated  deeply  in  the  head  and  the  brows  overhang  it. 
Pointed  objects  may,  however,  enter  it.  When  this  occurs 
severe  damage  almost  always  results. 

The  symptoms  are  severe  pain  and  redness  of  the  eye,  and  if 
a  wound  has  been  inflicted  it  is  usually  easy  to  see  the  cut.  Such 
injuries  should  be  treated  by  a  doctor.  Therefore,  in  any  injury 
of  the  eyeball,  cover  both  eyes  with  absorbent  cotton  or  soft 
cloths,  soaked  in  cool  water,  so  as  to  keep  the  eyelids  still,  and 
bandage  them  into  place  with  bandages  around  the  head.  Be 
careful  not  to  put  on  these  bandages  so  tightly  that  they  will 
press  on  the  eyeballs,  and  in  order  to  prevent  inflammation  keep 
them  constantly  wet  with  cool  water  until  the  services  of  a  doctor 


60       INJURIES   IN   WHICH   THE   SKIN  IS  PIERCED   OR  BROKEN 

can  be  procured.  While  boiled  water  is  safer  for  this  purpose 
there  is  little  danger  in  the  use  of  any  clean  water. 

Splinters  in  the  eye  should  be  pulled  out  if  possible.  If  they 
cannot  be  removed,  put  a  few  drops  of  olive  or  castor  oil  in  the 
eye.  Whether  removed  or  not,  the  eyes  should  be  treated  in  the 
manner  just  described  and  a  doctor  should  be  consulted  as  soon 
as  possible. 

Foreign  bodies  in  the  eye  are  usually  cinders,  sand  or  particles 
of  dust.  They  cause  a  great  deal  of  discomfort  and  pain,  and 
tears,  which,  fortunately,  often  wash  them  out. 

Never  rub  the  eye,  as  this  will  be  likely  to  rub  the  foreign  body 
into  its  delicate  covering. 

First,  close  the  eye  so  that  the  tears  will  accumulate  and  the 
foreign  body  will  frequently  be  washed  out  or  into  view,  so  that  it 
may  be  easily  removed.  If  this  fails,  pull  the  upper  lid  over  the 
lower  two  or  three  times,  close  the  nostril  on  the  opposite  side 
with  the  finger  and  have  the  patient  blow  his  nose  hard. 

If  the  foreign  body  still  remains  in  the  eye,  examine  first  under 
the  lower,  then  under  the  upper  lid.  For  the  former,  have  the 
patient  look  up,  press  the  lower  lid  down  and  if  the  foreign  body 
is  seen  brush  it  off  with  the  corner  of  a  clean  handkerchief.  The 
upper  lid  is  not  so  easy  to  see.  Seat  patient  in  a  chair  with  his 
head  bent  backward.  Stand  behind  him  and  place  a  match 
across  the  upper  lid  one-half  inch  from  its  edge.  Turn  the  upper 
lid  up  and  back  over  the  match  and  brush  off  the  foreign  body  as 
before.  A  few  drops  of  castor  oil  in  the  eye  after  removing  a 
foreign  body  will  soothe  it. 

Above  all  things  do  not  be  rough,  however,  or  you  may  do 
very  serious  injury.  If  you  experience  any  difficulty  in  removing 
any  speck  from  the  eye  it  is  much  safer  to  bandage  a  pad  wet  with 
clean  water  on  it  and  to  take  the  patient  to  a  doctor. 

Lime  in  the  eye  may  be  neutralized  by  bathing  it  with  a  solu- 
tion of  vinegar,  a  teaspoonful  to  a  cupful  of  water.  Particles  of 
lime  large  enough  to  be  seen  should  be  removed  like  other  foreign 
bodies. 

Poisoned  Wounds. — This  name  is  given  to  wounds  into  which 
a  poison  other  than  pus  germs  is  introduced.     Special  treatment 


SNAKE   BITE  6l 

is  necessary  in  order  to  remove  and  combat  the  effects  of  this 
poison  on  the  body.  Snake  bite,  bites  of  dogs  and  cats,  lockjaw 
and  stings  and  bites  of  insects  and  spiders  will  be  discussed  here. 

i.  Snake  Bite 

Snake  bites  are  rare  injuries  in  this  country,  but  bites  from 
poisonous  snakes  are  so  rapidly  fatal  if  not  promptly  given 
proper  attention  that  it  is  necessary  for  the  student  of  first  aid 
to  know  how  to  treat  them.  The  rattlesnake  and  the  moccasin 
are  probably  most  generally  to  be  feared  in  the  United  States. 

Prevention. — When  it  is  impossible  to  avoid  the  localities 
where  poisonous  snakes  are  commonly  found,  comprises  the 
wearing  of  high  boots  or  leggings  by  day  and  sleeping  on  a  cot 
or  raised  platform  at  night  instead  of  on  the  ground.  The 
Mexican  plan  when  sleeping  on  the  ground  of  surrounding  the 
sleeper  with  a  hair  rope  or  lariat  is  undoubtedly  a  good  one,  as 
snakes  will  not  cross  such  a  rope. 

Symptoms. — Great  pain  in  the  wound.  Rapid  swelling. 
Much  depression  and  weakness,  followed  promptly  by  death  in 
some  cases  unless  proper  treatment  is  given. 

Treatment. — Immediately  tie  a  string,  handkerchief  or  band- 
age between  the  bitten  part  and  the  body  if  this  is  practical. 
Naturally,  this  can  only  be  done  in  the  limbs.  This  cutting  off 
of  the  return  of  the  blood  to  the  body,  of  course,  prevents  absorp- 
tion of  the  poison.  The  wound  should  then  be  soaked  in  hot 
water  if  this  is  obtainable  and  in  any  event  squeezed,  milked, 
or  sucked.  This  is  for  the  purpose  of  extracting  as  much  poison 
as  possible.  Sucking  the  wound  is  not  dangerous  unless  one  has 
cuts  or  scrapes  in  the  mouth.  These  procedures  should  not  be 
delayed  for  a  moment  in  order  to  send  for  a  doctor  but  one  should 
be  summoned  as  soon  as  possible.  The  further  first-aid  treat- 
ment consists  of  burning  or  cauterizing  the  bite  with  ammonia. 
Strong  ammonia  should  be  used  for  this  purpose.  The  patient 
should  also  be  dosed  with  stimulants.  It  is  not  necessary  to 
give  whisky  or  brandy  so  as  to. intoxicate  him.  But  a  large 
drink  of  whisky  or  brandy  or  a  big  dose  of  aromatic  spirits  of 


62        INJURIES    IN   WHICH   THE   SKIN   IS   PIERCED    OR  BROKEN 

ammonia  should  be  given  at  once  and  should  be  repeated  as  often 
as  seems  necessary  to  keep  up  the  strength.  Do  not  be  afraid 
to  give  too  much,  for  persons  bitten  by  poisonous  snakes  require 
a  large  amount  of  stimulants. 

Leave  the  string  or  bandage  tied  above  the  wound  in  place  as 
long  as  you  dare.  After  an  hour,  however,  you  must  remember 
your  tight  bandage  is  likely  to  cause  mortification  as  it  has  cut 
off  the  circulation.  It  must  therefore  be  loosened.  Never  try 
to  remove  it  all  at  once  but  loosen  it  a  little  so  that  only  a  small 
amount  of  poison  will  be  carried  into  the  body,  then  tighten  and 
repeat  after  a  few  moments  if  the  patient  does  not  seem  to  be 
greatly  affected  by  the  poison.  In  this  way  you  may  finally  be 
able  to  remove  the  constricting  band  entirely.  But,  on  the  other 
hand,  if  the  poison  which  escapes  into  the  body  seriously  depresses 
the  patient  you  must  keep  the  bitten  part  tied  off  and  take 
chances  on  mortification. 

2.  Dog  and  Cat  Bites 

The  teeth  of  a  dog,  and  to  a  less  extent  those  of  a  cat,  make  a 
rather  nasty  lacerated  wound.  These  are  treated  like  all  other 
similar  wounds  unless  the  biting  animal  is  rabid  or  is  suspected 
of  being  rabid.  Rabies  is,  of  course,  the  same  as  hydrophobia. 
Cows,  horses,  wolves,  foxes  and  deer  also  have  hydrophobia. 

The  first  thing  to  do  for  such  a  bite  is  exactly  like  that  for 
snake  bite:  tying  off,  hot  water  and  squeezing  to  encourage 
bleeding,  and  then  burning.  Of  course  a  red  hot  wire  may  be 
used  for  burning  the  wound  as  well  as  strong  ammonia  or  nitric 
acid.  Lunar  caustic,  though  so  commonly  used,  is  not  of  much 
value. 

As  soon  as  the  bite  has  been  cauterized,  remove  the  constricting 
band  and  dress  like  any  wound.     Treat  shock. 

When  possible  it  is  best  to  have  a  doctor  see  such  bites  at  once. 
But  in  any  event  you  should  never  neglect  consulting  him  as 
early  as  practical  on  account  of  the  dangers  of  hydrophobia, 
which  is  a  terrible  disease  that  may  be  easily  prevented  but  is 
never  cured. 


STINGS    AND  BITES    OF  INSECTS  63 

3.  Lockjaw 

The  scientific  name  for  this  is  tetanus.  It  is  due  to  a  special 
germ  which  takes  time  to  develop  in  the  body  so  just  as  with 
pus  germs  nothing  wrong  is  noticed  immediately  after  a 
wound  is  received.  The  point  to  be  remembered  is,  how- 
ever, that  lockjaw  can  be  prevented  by  proper  treatment  but 
that  it  is  almost  never  cured.  Lockjaw  develops  particularly 
in  ragged  torn  wounds  into  which  dirt  has  been  ground  and 
sometimes  in  wounds  due  to  rusty  nails.  It  is  much  safer  to 
have  a  doctor  see  such  wounds  as  soon  as  possible. 

4.  Stings  and  Bites  of  Insects  and  Spiders 

These  are  rarely  dangerous  to  life,  though  they  may  cause  a 
great  deal  of  pain  and  discomfort.  Ammonia  should  be  imme- 
diately applied  to  the  part  where  the  sting  entered;  this  should 
be  removed  if  it  remains  in  the  wound.  Afterward  cool,  wet 
dressings  should  be  used.  Cloths  wet  with  water  in  which  a  very 
few  drops  of  carbolic  acid  have  been  thoroughly  mixed,  wet 
salt,  and  wet  earth  are  all  good  applications. 

QUESTIONS 

1.  What  is  a  wound? 

2.  What  is  the  special  danger  to  be  feared  in  a  wound? 

3.  How  does  the  skin  protect  the  body? 

4.  What  is  the  difference  in  the  effect  produced  on  the  body  by  a 
mechanical  or  a  chemical  cause  and  by  germs? 

5.  How  can  a  germ  enter  the  body? 

6.  Where  are  the  germs  found? 

7.  What  does  disinfection  mean? 

8.  What  happens  in  a  wound  if  germs  gain  entrance  to  it?     If  they 
do  not  gain  entrance  to  it? 

9.  How  does  free  bleeding  diminish  the  danger  of  wound  infection? 

10.  What  is  inflammation? 

11.  What  is  blood-poisoning? 

12.  How  would  you  prevent  pus  germs  entering  a  wound? 

13.  What  are  the  symptoms  of  inflammation  in  a  wound? 


64      INJURIES   IN   WHICH  THE   SKIN  IS   PIERCED    OR  BROKEN 

14.  When  do  they  come  on  and  what  should  you  do  if  they  appear? 

15.  What  are  the  varieties  of  wounds? 

16.  What  are  the  symptoms  of  wounds? 

17.  How  would  you  treat  an  ordinary  wound? 

18.  Why  should  one  try  to  make  a  trivial  wound  bleed? 

19.  What  dressing  would  you  prefer  to  use  for  a  wound? 

20.  How  would  you  prepare  a  wound  dressing? 

21.  State  what  you  know  of  the  use  of:  Strong  antiseptics;  peroxide 
of  hydrogen;  collodion;  plaster. 

22.  What  is  the  treatment  for  an  abdominal  wound? 

23.  What  do  you  understand  by  foreign  body? 

24.  How  would  you  treat  a  wound  in  which  there  is  a  foreign  body? 

25.  How  do  you  treat  an  eye  wound? 

26.  How  would  you  remove  a  speck  from  the  eye? 

27.  What  are  the  dangers  in  removing  foreign  bodies  from  the  eye? 

28.  What  are  poisoned  wounds? 

29.  What  would  you  do  for  a  snake  bite? 

30.  What  is  hydrophobia  and  how  is  it  caused? 

31.  What  is  lockjaw?     How  is  it  prevented? 

32.  What  is  the  treatment  of  bites  and  stings? 

PRACTICAL  EXERCISES 

1.  Show  wound  dressings  and  their  method  of  application. 

2.  Have  each  member  of  the  class  put  on  such  a  dressing  in  such  a 
way  that  neither  the  dressing  nor  the  wound  is  contaminated. 

3.  Show  how  to  treat  a  snake  bite. 

4.  Show  the  way  to  remove  a  foreign  body  from  the  eye. 


CHAPTER  V 
BLEEDING 

As  stated  under  the  head  of  wounds  in  ninety-nine  cases  out 
of  a  hundred  exposure  to  the  air  or  the  pressure  of  the  dressing 
is  all  that  is  necessary  to  stop  bleeding.  Do  not  become  hurried 
or  alarmed  when  there  is  a  little  bleeding  but,  on  the  other  hand, 
remember  that  if  much  blood  is  being  lost  you  must  check  it 
promptly  or  the  injured  person  may  soon  be  beyond  human  aid. 
In  order  that  one  may  know  how  to  stop  severe  bleeding  it  is 
necessary  to  know  something  of  the  heart  and  the  blood-vessels, 
of  the  course  of  the  blood  and  of  the  blood  itself,  and  these  will 
now  be  described. 

The  Heart. — In  order  that  the  blood  may  reach  all  parts  of  the 
body  it  is,  of  course,  necessary  that  some  force  shall  propel  it. 
This  is  provided  by  the  Heart,  which  is  not  the  seat  of  the  feel- 
ings, but  a  most  skillfully  devised  pumping  machine. 

The  heart  is  about  the  size  of  a  man's  fist  and  is  located  in  the 
chest  between  the  lungs.  It  is  a  hollow,  muscular  organ,  with 
valves  which  close  and  prevent  the  blood  from  flowing  back- 
ward, all  its  force  being  expended  to  send  the  blood  forward. 
The  beat  of  the  heart  which  we  feel  in  the  chest  is  its  contraction 
by  which  it  is  made  smaller  inside,  thus  forcing  the  blood  to  the 
furthest  parts  of  the  body.  After  the  heart  contracts  it  dilates 
or  becomes  larger  inside  and  the  valves  open  so  that  it  may  fill 
with  blood.  The  next  contraction  again  forces  the  blood  for- 
ward, and  so  on  as  long  as  a  person  is  alive. 

The  heart  contracts  usually  about  72  times  per  minute. 

While,  as  has  just  been  stated,  the  heart  is  a  pump,  it  is  not  a 
single  but  a  double  pump,  being  divided  into  two  entirely  sepa- 
rate halves  by  a  muscular  partition.  The  left  side  of  the  heart, 
5  65 


66  BLEEDING 

or  the  left  pump,  drives  the  blood  through  the  body,  and  the  right 
side  drives  it  through  the  lungs  alone. 

Blood-vessels. — A  series  of  closed  tubes,  or  blood-vessels, 
as  they  are  called,  carry  the  circulating  blood.  They  are  of  three 
classes:  i,  Arteries;  2,  Capillaries,  and  3,  Veins. 

1.  Arteries. — Leaving  the  left  side  of  the  heart  is  the  largest 
artery  in  the  body — the  Aorta.  This  strong  tube  is  just  about 
large  enough  so  that  a  man's  thumb  may  be  introduced  into  it 
when  it  is  separated  from  the  heart.  It  soon  divides  into 
branches  which  again  branch  and  rebranch,  the  branches  con- 
stantly growing  smaller  in  size,  to  reach  finally  the  furthest  parts 
of  the  body.  It  should  be  remembered,  too,  that  the  smaller 
branches  of  the  arteries  join  freely  with  one  another.  The 
blood  passes  from  the  heart  to  the  aorta  and  thence  to  the  smaller 
arteries,  not  in  a  steady  stream  but  in  waves,  each  of  which  is 
produced  by  a  contraction  of  the  heart.  The  beat  of  these  waves 
causes  the  Pulse,  which  may  be  felt  not  only  at  the  wrist  and 
temple,  but  also  anywhere  else  an  artery  is  near  enough  the  sur- 
face of  the  body.  Naturally,  if  an  artery  is  cut,  there  will  not 
be  a  steady  stream  flowing  from  it,  but  the  blood  will  be  expelled 
in  spurts  or  jets.  Arteries,  especially  those  of  large  size,  remain 
open  when  divided. 

As  the  course  of  the  blood  in  the  arteries  is  away  from  the  heart 
toward  the  limbs  and  the  head,  if  an  artery  is  cut,  in  order  to 
stop  the  bleeding  the  artery  must  be  compressed  either  on  the 
side  of  the  heart  or  on  the  bleeding  point  itself.  Pressure  on  the 
further  side  of  the  cutwill,  as  may  be  easily  understood,  do  no  good 
so  far  as  stopping  bleeding  from  an  artery  is  concerned.  It  is  also 
necessary  to  press  on  the  artery  on  the  near  or  heart  side  as  close 
to  the  bleeding  point  as  possible.  This  is  because  arteries  in 
their  branching  and  re-branching  join  each  other,  and  if  pressure 
is  made  on  any  artery  far  above  the  bleeding  point,  so  many 
branches  may  bring  blood  into  it  between  the  point  of  pressure 
and  the  bleeding  point  that  a  great  deal  of  blood  will  be  lost, 
notwithstanding  the  fact  that  the  main  branch  is  blocked  by 
pressure  at  a  distant  point.  However,  it  is  not  in  every  part 
of  the  body  that  arteries  lie  near  enough  to  the  surface  to  be 


ARTERIES  AND  PRESSURE  POINTS 


67 


Temporal 


Brachial 
(At  bend  of  elbow) 


Popliteal 
(At  back  of  knee) 


—  Brachial 


-Femoral 


Plate  XI. — The  arteries  and  pressure  points. 


68 


BLEEDING 


compressed  in  their  course.  Moreover,  it  is  necessary  in  com- 
pressing an  artery  to  select  a  point  where  a  nearby  bone  gives 
a  hard  surface  to  press  against.  Therefore,  the  student  of  first 
aid  must  know,  first,  the  situation  and  course  of  the  principal 
arteries  and,  second,  the  points  on  which  pressure  will  be  effective. 

The  aorta  has  three  great  branches  which  are  of  particular 
interest  to  the  student  of  first  aid.  One  of  these,  the  Carotid, 
supplies  the  head  and  neck  with  blood;  the  second,  the  Sub- 
clavian, the  upper  limbs;  and  the  third,  the  Femoral,  the  lower 
limbs. 

The  table  which  follows  gives  certain  necessary  information 
regarding  these  arteries  and  their  branches. 

Arterial  bleeding  is  always  more  serious  than  other  bleeding 
because  blood  is  so  rapidly  lost  being  forced  from  the  cut  artery 
in  jets  with  every  beat  of  the  heart.  The  blood  which  spurts 
from  an  artery  is  always  bright  red  in  color. 

2.  Capillaries. — The  arteries,  as  they  go  further  and  further 
from  the  heart,  become  smaller  and  thinner-walled,  till  they 
finally  end  in  still  smaller  vessels  which  are  called  capillaries, 
from  the  Latin  word  meaning  a  hair.  The  capillaries  form  a  deli- 
cate network  of  vessels  everywhere,  and  give  the  rosy  color  to 
the  skin.  Slight  pressure  on  the  skin  will  cause  a  white  spot  to 
appear.  This  is  because  the  pressure  has  forced  the  blood  from 
the  net-work  of  capillaries  and  the  white  skin  is  seen  instead  of 


Head  and  Neck 


Artery 


Course 


Point  on  which  to 
make  pressure 


Carotid. 


Temporal  (a  branch  of 
carotid). 


From  upper,  outer 
edge  of  breast-bone 
to  angle  of  jaw. 

Upward,  one-half  inch 
in  front  of  ear. 


Deep.  Down  and  back, 
an  inch  to  the  outer 
side  of  Adam's  apple. 

On  skull,  immediately 
in  front  of  upper  part 
of  ear. 


ARTERIES 

Upper  Extremity 


69 


Artery 


Point  on  which  to 
exert  pressure 


Subclavian. 


Brachial  (a  branch  of 
a  branch  of  the  sub- 
clavian). 


Across  the  middle  of 
first  rib  to  arm  pit. 


Descends  along  inner 
side  of  big  muscle  at 
front  of  upper  arm; 
about  line  of  seam  of 
coat,  to  just  below 
center  of  crease  at 
bend  of  elbow. 


Deep.  Down  and  back 
over  center  of  collar- 
bone on  first  rib. 
Shoulder  should  be 
drawn  down  first. 

Against  bone  of  upper 
arm  by  grasping  and 
pulling  big  muscle  to 
outer  side.  Or  at 
elbow  by  putting  a 
tight  roll  of  cloth  or 
a  rolled  bandage  in 
bend  of  elbow,  and 
bending  up  arm  as 
much  as  possible. 


Lower  Extremity 


Femoral 

Down     thigh     from 
pelvis  to  knee,  line 

Against  bone  of  thigh 
high  up  inner  side  in 

from  middle  of  line 

line  given  about  three 

between  point  of  hip 

inches    below    upper 

and  center  of  pelvis 

end  of  line. 

in  front  to  inner  side 

of  knee. 

Popliteal  (a  continua- 

Down  in    middle   of 

In   bend   of   knee   as 

tion  of  the  femoral). 

space  at  the  back  of 
knee-joint. 

described  for  elbow. 

the  rosy  color  due  to  the  presence  of  the  blood  in  the  capillaries. 
In  capillaries  the  pulse,  or  contraction  wave  from  the  heart,  is 
no  longer  apparent,  as  these  fine,  hair-like  tubes  break  up  the 
waves.     Slight  cuts  or  pricks  of  the  skin  divide  some  capillaries 


70 


BLEEDING 


I.  Point  of  Pressure  on  Carotid  Artery 
for  cut  above 


3.  Tourniquet  on  Brachial  Arterv 


5.  Pad  on  Temporal 
Artery 


Pad  in  Space  at 
Back  of  Knee  to 
Prevent  Bleed- 
ing  below 


Plate  XII.— Stopping  bleeding. 


THE  BLOOD  7  I 

and  therefore  cause  bleeding.  Naturally,  on  account  of  the 
minute  size  of  these  vessels,  bleeding  from  them,  except  from  a 
very  large  surface,  is  not  dangerous  to  life.  Capillaries  branch 
so  freely  that  pressure  used  to  check  capillary  bleeding,  to  be 
effective,  must  be  made  on  the  bleeding  point. 

The  blood  lost  from  capillaries  is  no  longer  bright  red  in  color 
like  that  from  arteries,  but  is  somewhat  darker. 

3.  Veins. — The  blood-vessels  which  return  the  blood  to  the 
heart  from  the  points  furthest  from  it  are  called  veins.  They 
may  be  easily  recognized  as  the  blue  lines  under  the  skin.  Cap- 
illaries unite  to  form  small  veins,  these  unite  to  form  larger  veins, 
and  finally  these  vessels  become  very  large  before  entering  the 
right  side  of  the  heart.  The  best  known  of  the  large  veins  is 
probably  the  jugular  vein  of  the  neck. 

Bleeding  from  a  cut  vein  is  in  a  continuous  flow  instead  of  in 
jets  as  is  the  case  with  bleeding  from  arteries,  and  it  is  mainly 
through  this  difference  that  one  distinguishes  venous  from  arterial 
hemorrhage.  Venous  blood,  too,  is  dark,  bluish-red  in  color, 
as  the  oxygen  in  the  blood  is  lost  in  its  passage  through  the 
capillaries.  While  bleeding  from  veins  has  not  the  almost 
terrifying  appearance  of  arterial  bleeding,  a  dangerous  amount  of 
blood  may  be  lost  from  a  large  vein.  As  the  course  of  the  blood 
in  the  veins  is  toward  the  heart,  in  stopping  bleeding  from  them 
pressure  must  never  be  made  on  the  side  toward  the  heart,  but 
on  the  bleeding  point  or  on  the  side  away  from  the  heart. 

The  Blood. — The  blood  is  a  fluid  which  carries  properly  pre- 
pared food,  oxygen,  and  heat  to  feed  and  warm  all  parts  of  the 
body,  from  which  it  also  removes  waste  materials  for  final  expul- 
sion. These  processes  go  on  constantly  as  long  as  life  lasts, 
Coagulation  or  clotting  is  the  property  of  the  blood  which  is  of 
most  interest  to  the  student  of  first  aid.  While  the  blood  is 
circulating  in  the  living  vessels  it  remains  fluid,  but  as  soon  as  this 
influence  is  removed  it  coagulates  or  clots,  thus  tending  to  stop 
bleeding.  It  is  easy  to  see  if  Nature  did  not  provide  this  safe- 
guard that  the  slightest  scratch  sufficient  to  draw  blood  would 
result  in  the  loss  of  all  the  blood  in  the  body.  The  rate  of  loss 
would  be  regulated  simply  by  the  size  of  the  opening  just  as  is 


72  BLEEDING 

that  of  water  flowing  from  a  pipe.  Very  rarely  a  person  is 
found  whose  blood  does  not  clot.  These  people  are  called 
"bleeders,"  and  they  often  bleed  to  death  from  a  trivial  injury, 
such  as  the  pulling  of  a  tooth. 

All  efforts  to  stop  bleeding  have  as  their  object  clotting  of  the 
blood  so  that  the  clots  will  plug  the  bleeding  vessels.  Therefore, 
we  must  know  the  best  way  to  help  the  clots  to  form.  In  order 
to  clot,  blood  must  be  at  comparative  rest.  A  spouting  stream  of 
blood  will  never  clot.  This  is  one  reason  why  bleeding  from 
arteries'  is  particularly  dangerous.  As  soon  as  we  stop  the  bleed- 
ing the  blood  begins  to  clot  but  not  before.  Any  foreign  material, 
especially  if  it  has  many  points  on  which  clots  may  form,  will  help 
in  the  formation  of  clots.  Surgical  gauze  is  a  good  example  of 
such  a  material.  Cobwebs  are  also,  and  they  were  much  used  even 
by  surgeons  before  the  danger  of  dirt  in  a  wound  was  so  well 
understood. 

Symptoms  from  Loss  of  Blood. — Besides  the  actual  appearance 
of  blood  in  hemorrhage,  the  loss  of  a  considerable  amount  of  blood 
gives  rise  to  certain^symptoms:  Faintness,  with  cold  skin,  pale 
face,  dilated  pupils,  feeble,  irregular  breathing,  sighing,  weak 
pulse,  dizziness  and  loss  of  consciousness.  The  severity  of  the 
symptoms  depends  on  how  much  and  how  rapidly  blood  is  lost. 

Treatment  of  Wounds  with  Severe  Bleeding. — Check  the 
bleeding.  Put  the  injured  person  in  such  a  position  that  he 
will  be  least  affected  by  the  loss  of  blood.  This  is  lying  down  with 
the  head  low  so  that  the  brain  will  get  as  much  blood  as  possible. 
Do  nothing  which  will  increase  bleeding.  Violent  movements 
must  be  prevented.  When  once  the  bleeding  has  ceased  the 
injured  person  should  remain  quiet,  as  any  -movement  may 
dislodge  the  clot  and  start  it  again.  See  that  the  patient  gets 
plenty  of  good  air,  cover  him  warmly  and  put  hot  bottles  around 
him  if  they  can  be  obtained.  Naturally,  stimulants  increase 
the  force  of  the  heart,  so  they  are  undesirable;  but  sometimes  the 
injured  person  becomes  so  weak  that  it  is  absolutely  necessary  to 
give  them  to  prevent  him  from  dying.  Whenever  possible, 
always  avoid  doing  so  until  the  bleeding  has  been  checked  by 
some    mechanical   means.    One-half   teaspoonful   of   aromatic 


WOUNDS    WITH   SEVERE  BLEEDING 


73 


5.  Point 

for  Thigh 


6.  Bleeding  from  an  Artery 


Plate  XIII.— Bleeding. 


74  BLEEDING 

spirits  of  ammonia  in  a  tablespoonful  of  water  or  a  tablespoonful 
of  whisky  are  good  stimulants. 

When  a  patient  is  in  a  state  of  collapse  from  loss  of  blood  his 
death  may  often  be  prevented  by  forcing  the  blood  into  the  body 
from  the  limbs.  This  is  done  by  raising  the  feet  and  bandaging 
the  legs  from  the  toes  to  the  body  and  by  bandaging  the  arms 
from  the  tips  of  the  fingers  to  the  arm  pits. 

In  order  to  check  bleeding  it  is  necessary  to  know  from  which 
kind  of  a  blood  vessel  it  comes. 

i.  Arterial  hemorrhage  is  recognized  by  bright  red  blood 
expelled  in  jets.     The  blood  is  lost  very  rapidly. 

2.  Venous  hemorrhage  is  recognized  by  a  steady  flow  of  dark 
blue  blood. 

3.  Capillary  hemorrhage  is  characterized  by  the  oozing  of 
blood  of  a  brick  color.  * 

Hemorrhage  will  not  be  severe  except  from  arteries  and  large 
veins. 

Naturally,  as  arteries,  capillaries  and  veins  may  all  be  cut  in  a 
wound,  there  may  be  bleeding  from  all  three.  In  this  case 
arterial  hemorrhage  demands  first  consideration,  and  with 
venous  and  capillary  hemorrhage  the  latter  may  be  disregarded 
for  the  time  being. 

Arterial  Hemorrhage 

Treatment. — Send  for  a  doctor  at  once.  Do  not  wait  for  him, 
for  by  so  doing  the  patient  may  die  or  be  in  a  hopeless  condition 
when  he  arrives.  If  necessary,  cut  off  clothing  at  once  so  as  to 
see  bleeding  point.  In  very  severe  bleeding  take  the  next  step 
before  doing  this.  Press  with  your  fingers  or  thumb  on  the  artery 
between  the  bleeding  point  and  the  heart.  This  stops  the  bleed- 
ing just  as  you  can  check  the  water  flowing  from  a  hose  by  press- 
ure in  any  part  of  its  length.  It  does  more  than  this,  however. 
Nature's  method  of  checking  hemorrhage  is  by  the  formation  of 
a  clot,  and  as  pressure  prevents  the  washing  away  of  the  blood 
beyond  the  point  of  pressure  an  opportunity  is  given  for  a  clot 
to  form. 

The  points  where  pressure  can  best  be  made  on  arteries  in  their 


ARTERIAL  HEMORRHAGE  75 

course  have  already  been  given,  but  it  will  be  best  to  say  a  few 
words  more  on  this  subject. 

Bleeding  from  any  part  of  the  scalp  may  be  stopped  by  a  tight 
bandage  around  the  head.  This  bandage  should  encircle  the 
head,  going  across  the  forehead  just  above  the  ears  to  the  back 
of  the  head  behind. 

Bleeding  from  the  side  of  the  head  above  may  also  be  stopped 
by  pressure  on  the  temporal  artery  in  front  of  the  ear  just  above 
where  the  lower  jaw  may  be  felt  working  in  its  socket. 

All  arterial  bleeding  from  the  head  except  that  already  referred 
to  and  from  the  neck  above  had  best  be  checked  by  pressure  on 
the  carotid  artery.  To  make  such  pressure  press  backward 
with  the  thumb  or  fingers  deeply  into  the  neck  just  to  the  inner 
side  of  the  plainly  seen  muscle  which  reaches  from  the  upper  part 
of  the  breast  bone  to  behind  the  ear. 

Wounds  of  the  neck  whether  from  arteries  or  veins  are  so  imme- 
diately and  extremely  dangerous,  however,  that  for  them  direct 
pressure  on  the  bleeding  point  should  be  resorted  to  at  once. 

In  bleeding  from  wounds  of  the  shoulder  or  arm-pit,  the  sub- 
clavian artery  may  be  reached  by  pressing  the  thumb  deeply  into 
the  hollow  just  above  and  behind  the  center  of  the  collar  bone. 
(Plate  XII.) 

In  bleeding  from  any  part  of  the  arm  or  hand,  the  brachial 
artery  is  usually  pressed  outward  against  the  bone  just  behind 
the  inner  border  of  the  large  muscle  of  the  upper  arm.  (Plate 
XII.)     This  artery  runs  about  with  the  seam  of  the  coat. 

Another  method  is  to  put  a  firm  pad  of  gauze  or  cloth  about  the 
size  of  a  small  egg  at  the  bend  of  the  elbow,  to  close  the  joint 
tight  and  to  bandage  in  this  position. 

For  the  hand  alone,  pressure  on  the  pulse  at  the  outer  side  of 
the  wrist  and  at  the  same  place  at  the  inner  side  will  stop  bleed- 
ing.   Two  little  pads  may  be  used  for  this. 

While  bleeding  in  the  palm  may  be  checked  in  these  ways, 
direct  pressure  by  means  of  a  stone  wrapped  in  gauze  or  the  like 
firmly  bandaged  in  the  palm  with  the  hand  closed  upon  it  is 
much  better. 

In  bleeding  from  the  thigh,  leg  or  foot,  press  backward  with  the 


76  BLEEDING 

thumbs  at  the  middle  of  the  groin  where  the  artery  passes  over 
the  bone.  This  is  four  ringer  breadths  below  the  fold  of  the 
groin. 

For  bleeding  below  the  knee,  a  pad  about  the  size  of  a  billiard 
ball  is  placed  in  the  bend  of  the  knee,  the  joint  is  bent  on  it  and 
is  bandaged  in  this  position  just  as  is  done  in  the  elbow-joint. 

In  making  pressure  with  the  ringers,  if  you  feel  the  beat  of  the 
artery,  you  may  be  quite  sure  that  with  a  little  care  to  get  it 
between  your  ringers  and  the  hard  point  you  can  check  the 
bleeding.  If  you  have  stopped  the  bleeding  in  the  manner  just 
described,  you  may  also  be  quite  sure  that  the  patient  is  safe  so 
long  as  you  continue  the  pressure. 

You  will  hardly  be  able  to  do  this  for  more  than  ten  or  fifteen 
minutes,  however,  as  your  fingers  will  become  tired  and  cramped. 
It  will  be  best,  therefore,  in  wounds  of  the  extremities  to  have 
a  tourniquet  made  to  place  around  the  limb  against  your  fingers 
with  the  pad  on  the  artery;  the  tourniquet  then  to  be  twisted, 
or  in  proper  cases  the  elbow  or  knee  pads  may  be  used  in  place 
of  the  tourniquet. 

One  of  these  methods  will  usually  be  all  that  is  necessary  if  the 
services  of  a  doctor  can  be  procured  within  two  or  three  hours. 
If  this  is  not  the  case  you  will  be  in  a  serious  position.  If  either 
apparatus  is  left  in  place  much  longer  than  this  there  is  consider- 
able danger  from  cutting  off  the  blood-supply  that  you  will 
cause  the  death  of  the  part  below.  No  part  of  the  body  can  do 
without  blood  for  a  long  period.  Yet  if  the  pressure  is  removed 
the  bleeding  may  recommence.  Under  such  circumstances, 
therefore,  leave  the  tourniquet  or  pad  in  position  as  long  as  you 
dare,  say  two  hours.  In  the  meantime  procure  an  antiseptic 
compress  or  have  one  prepared  in  the  manner  already  described. 
Place  this  gently  on  the  wound  and  bandage  firmly  in  place  so 
as  to  make  strong  pressure  on  the  bleeding  point.  The  pressure 
between  the  heart  and  the  wound  may  now  be  gradually  released. 
If  the  bleeding  does  not  recommence,  well  and  good;  if  it  does, 
the  tourniquet  or  pad  must  be  reapplied.  Another  attempt  to 
remove  it  should  not  be  made  for  at  least  an  hour,  as  time  is 
needed  for  the  clot  to  reform. 


TOURNIQUETS  77 

Suppose,  at  first,  and  this  is  not  wholly  improbable,  that 
you  have  failed  to  stop  the  bleeding  by  pressure  between  the 
heart  and  the  bleeding  point — there  is  still  no  reason  why  you 
should  become  panic  stricken.  Of  course  you  do  not  want  to 
put  your  ringers  in  the  wound  as  this  will  be  very  likely  to  infect 
it,  but  in  case  of  a  severe  arterial  hemorrhage  which  you  are 
unable  to  check  by  pressure  between  the  heart  and  the  bleeding 
point  you  must  at  once  make  pressure  on  the  cut  artery  in  the 
wound.  If  you  have  an  antiseptic  compress  or  a  surgically  clean 
cloth  to  put  over  your  fingers,  which  are  used  to  make  direct 
pressure,  so  much  the  better,  as  this  will  prevent  infection;  but 
do  not  wait  to  obtain  it.  When  direct  pressure  is  made  in  this 
way,  it  should  be  replaced,  if  possible,  by  a  compress  bandaged 
in  place  in  the  manner  which  has  already  been  described. 

With  wounds  of  the  smaller  arteries  if  a  compress  is  firmly 
bandaged  on  the  wound  at  the  beginning  it  will  often  be  all  that 
is  required  to  check  bleeding.  Position  is  also  of  value  in  stop- 
ping such  hemorrhage.  By  elevating  the  arm  or  leg  the  heart 
is  made  to  pump  against  gravity  and  a  much  better  chance  is 
given  for  a  clot  to  form  which  will  block  the  injured  artery. 

More  about  Tourniquets. — Tourniquets  are  instruments  used 
to  stop  bleeding  from  arteries.  Every  tourniquet  must  have  a 
strap  to  go  around  the  limb,  a  pad  to  place  on  the  artery  and 
some  means  by  which  the  pad  may  be  made  to  press  on  the 
artery  and  thus  to  stop  the  flow  of  blood.  In  an  improvised 
tourniquet,  which  is  the  type  most  commonly  used,  the  strap 
may  be  made  of  a  handkerchief,  towel,  bandage  or  cravat,  and  a 
smooth  round  stone,  a  cork  or  some  object  of  similar  shape  and 
size  may  be  used  for  the  pad.  The  stone,  or  the  like,  had  best 
be  wrapped  in  a  small  piece  of  cloth  so  that  it  will  not  bruise  the 
skin  too  much.  It  is  then  placed  over  the  artery  above  the 
wound  and  the  strap  is  best  passed  twice  around  the  limb  and 
tied  loosely  at  its  outer  side.  A  stick  is  introduced  between  the 
two  layers  thus  formed  and  is  twisted  around  until  the  bleeding 
is  stopped.  If  desired,  another  bandage  may  be  used  to  loop 
over  and  to  hold  the  end  of  the  stick  from  twisting  back  and  so 
relieving  the  pressure  of  the  pad  on  the  artery.    One  layer  of 


78  BLEEDING 

bandage  may  be  used  for  the  strap  if  more  is  not  procurable. 
In  order  to  avoid  bruising  in  using  this  it  is  best  after  introducing 
the  stick  into  the  loop  to  twist  away  from  the  body. 

The  inner  tube  of  a  bicycle  tire  makes  an  excellent  tourniquet. 
Its  end  is  used  for  the  pad. 

Ready  made  tourniquets  with  straps,  buckles,  and  pads  may 
be  bought.     They  are  more  convenient  to  use. 

Besides  the  bruising  of  the  muscles  and  skin  which  is  certain 
to  occur  to  some  extent  with  any  tourniquet,  there  is  a  much 
graver  danger  connected  with  their  use.  This,  as  has  been 
explained,  is  due  to  the  fact  that  in  consequence  of  cutting  off 
the  circulation,  mortification  and  death  of  the  part  may  follow. 
Therefore,  tourniquets  should  never  be  used  except  when  neces- 
sary and  they  should  be  removed  as  soon  as  possible.  In  doing 
this  loosen  the  tourniquet  and  allow  it  to  remain  loose  if  no 
bleeding  occurs.  It  should  not  be  removed  as  it  may  be  neces- 
sary to  tighten  it  again  quickly  should  bleeding  recommence. 

Instead  of  tourniquets,  appliances  to  make  pressure  on  the 
whole  circumference  of  a  limb  and  thus  to  stop  bleeding  are 
sometimes  employed.  A  special  elastic  bandage  and  elastic 
suspenders  have  been  recommended.  When  possible,  however, 
use  the  tourniquet,  as  cutting  off  the  whole  circulation  by  pres- 
sure on  the  entire  circumference  of  the  limb  is  much  more  likely 
to  cause  mortification  than  the  tourniquet  which  only  exerts  hard 
pressure  on  the  artery  alone.  If  circular  constriction  is  used  it 
should  never  be  employed  for  over  an  hour. 


Venous  Hemorrhage 

(Large  Veins) 

Treatment. — Stopping  bleeding  of  this  character  is  rather 
simple  as  compared  with  checking  arterial  hemorrhage.  Send 
for  a  doctor.  Remove  any  bands,  such  as  tight  collars,  belts, 
garters  and  clothing  which  prevent  the  return  flow  of  blood  to 
the  heart.  If  a  limb  be  wounded,  elevate  it  so  as  to  assist  the 
flow  of  blood  back  to  the  heart. 


INTERNAL  HEMORRHAGE  79 

Apply  a  compress  directly  to  wound  and  bandage  on  tightly. 
If  no  compress  can  be  obtained  which  is  surgically  clean  or 
antiseptic,  if  bleeding  is  very  severe  it  will  be  necessary  to  make 
direct  pressure  in  the  wound  with  the  ringers.  This  will,  of 
course,  be  done  at  the  risk  of  infecting  the  wound.  If  possible, 
keep  wounded  part  in  an  elevated  position  for  some  hours  after 
bleeding  has  stopped. 

With  wounds  of  the  neck,  such  as  those  caused  in  an  attempt 
to  cut  the  throat,  some  of  the  jugular  veins  are  often  divided. 
It  is  quite  probable  in  such  a  case  that  death  will  occur  before 
anything  can  be  done.  If  not,  jam  the  fingers  on  the  bleeding 
point  at  once  and  replace  them  with  a  compress  at  your  leisure. 
This  compress  should  be  bandaged  tightly  in  place. 

Varicose  Veins  are  veins  which  have  become  very  large  from 
weakening  of  their  walls.  Only  those  of  the  legs  need  be  con- 
sidered here.  They  may  burst  from  injury  or  without  an 
injury,  causing  serious  or  even  fatal  hemorrhage  if  they  are  not 
given  prompt  attention. 

Send  for  a  doctor  at  once.  Put  patient  on  his  back.  Remove 
all  bands  around  leg  above  bleeding  point.  Raise  leg.  Cut  and 
rip  clothing  so  as  to  get  at  bleeding  point.  Turn  back  clothing 
from  wound. 

Place  surgically  clean  or  antiseptic  compress  on  bleeding  point 
and  bandage  firmly  in  position,  or  when  absolutely  necessary 
use  fingers  first  for  direct  pressure  on  the  bleeding  point  and  re- 
place them  by  a  clean  compress.  Keep  patient  lying  down  for 
some  hours  with  the  leg  elevated. 

If  there  has  been  considerable  loss  of  blood,  cover  patient 
warmly  and  place  hot  bottles  around  him.  Give  stimulants 
only  when  absolutely  necessary  to  prevent  death,  as  they  will 
increase  the  force  of  the  heart  and  so  the  bleeding. 

Internal  Hemorrhage 

May  result  either  from  a  deep  wound  which  cuts  a  large  blood- 
vessel of  one  of  the  internal  organs  or  from  the  bursting  of  a 
blood-vessel  of  the  lungs  or  stomach. 


So  BLEEDING 

Symptoms. — Those  of  hemorrhage,  but  as  the  bleeding  is 
internal  it  will  not  be  seen. 

Treatment. — Send  for  a  doctor  at  once.  Put  patient  in  a 
lying-down  position  immediately,  with  his  head  lower  than  his 
body.  Apply  ice  or  cloths  wrung  out  in  very  cold  water  to  the 
point  from  which  you  think  the  bleeding  comes.  To  distinguish 
between  bleeding  from  the  lungs  and  stomach,  remember  that 
from  the  former  the  blood  is  bright  red  and  frothy  and  is  coughed 
up,  while  from  the  latter  it  is  dark  and  is  vomited.  Give  stimu- 
lants only  when  patient  is  becoming  very  weak. 

Nose-bleed 

Usually  this  does  not  result  from  a  wound,  but  comes  on 
spontaneously.  Slight  nose-bleed  does  not  require  treatment, 
as  no  harm  will  result  from  it. 

Treatment.  Severe. — Place  patient  in  a  chair  with  his  head 
hanging  backward.  Loosen  collar  and  anything  tight  around 
the  the  neck.  Apply  cold  to  the  back  of  the  neck  by  means 
of  a  key  or  of  a  cloth  wrung  out  in  cold  water. 

Put  a  roll  of  paper  under  the  upper  lip  between  it  and  the  gum. 
If  bleeding  does  not  cease,  salt  and  water,  a  teaspoonful  of 
salt  or  vinegar  to  a  cupful  of  water,  should  be  snuffed  up  the  nose. 

If  bleeding  still  continues,  send  for  a  doctor  to  come  at  once. 
Before  his  arrival  place  a  small  piece  of  cotton  or  gauze  in  the 
nostril  from  which  the  blood  comes  and  shove  it  in  gently  for 
about  i  inch.     A  pencil  answers  very  well  to  push  this  plug  in. 

Pinching  the  soft  part  of  the  nose  below  the  bone  will  also  help 
to  stop  bleeding. 

Stimulants  should  be  used  only  as  in  the  other  classes  of 
hemorrhage. 

QUESTIONS 

i.  What  is  the  purpose  of  the  heart?     Describe  its  action. 

2.  What  is  the  heart  beat  and  how  often  does  it  occur? 

3.  What  are  the  different  classes  of  blood-vessels;  describe  each. 

4.  What  are  the  characteristics  of  bleeding  from  an  artery? 


PRACTICAL   EXERCISES  8 1 

5.  In  bleeding  from  an  artery  where  would  you  press,  and  why? 

6.  Give  the  points  of  pressure  for  the  following  arteries:  Carotid, 
Temporal,  Subclavian,  Brachial  (2),  Femoral,  and  Popliteal,  and  ex- 
plain from  what  part  of  the  body  pressure  on  each  would  stop  arterial 
bleeding.  Tell  exactly  what  you  would  do  in  bleeding  from  a  large 
artery. 

7.  What  are  the  characteristics  of  bleeding  from  capillaries? 

8.  How  would  you  stop  bleeding  from  capillaries,  and  why? 

9.  What  are  the  characteristics  of  bleeding  from  veins? 

10.  How  would  you  stop  bleeding  from  veins? 

11.  What  is  the  blood?     What  does  it  do? 

12.  Describe  clotting  of  the  blood? 

13.  What  helps  to  make  the  blood  clot? 

14.  What  are  the  symptoms  of  great  loss  of  blood? 

15.  What  is  a  tourniquet?     What  are  its  uses  and  dangers? 

16.  How  would  you  treat  bleeding  from  a  varicose  vein? 

17.  Treatment  of  internal  hemorrhage? 

18.  Difference  between  bleeding  from  the  lungs  and  stomach? 

19.  Treatment  of  nose  bleed? 

PRACTICAL  EXERCISES 

1.  Show  the  course  of  the  arteries  on  the  subject  and  the  pressure 
points. 

2.  Show  how  a  tourniquet  is  used. 

3.  Have  each  member  of  the  class  show  how  to  stop  severe  bleeding 
from  an  artery  or  a  large  vein  at  the  same  time  dressing  the  wound 
properly. 


CHAPTER  VI 

INJURIES  DUE  TO  HEAT  AND  COLD 

Burns    and    Scalds;    Sunstroke   and   Heat   Exhaustion; 
Frost  Bite  and  Freezing 

BURNS  AND  SCALDS 

Description. — Burns  result  from  exposure  of  the  body  to  dry 
heat,  such  as  a  fire,  while  scalds  are  produced  by  moist  heat  in 
the  form  of  hot  water,  steam,  etc.  With  either,  the  injury  may 
be  confined  to  the  skin  alone  or  it  may  extend  deeper.  With 
burns  all  the  tissues  of  the  body  may  be  charred  down  to  the 
bone  and  with  scalds  all  the  tissues  may  be  actually  cooked. 
With  either  the  danger,  which  first  of  all  is  shock,  will  depend 
upon  the  depth,  extent  and  part  injured  as  well  as  on  the  age  of 
the  injured  person. 

In  children  and  old  people,  burns  and  scalds  are  particularly 
dangerous.  Both  burns  and  scalds  of  the  throat  and  windpipe 
often  cause  death,  as  the  swelling  of  the  injured  part  is  likely  to 
result  in  suffocation. 

Causes. — Burns:  Flames  or  fires,  hot  or  molten  metal,  the 
electric  current,  explosions  of  gas  or  gunpowder,  and  strong  acids 
and  alkalies. 

Scalds:  Steam,  boiling  water  or  hot  oil. 

Prevention. — The  prevention  of  burns  and  scalds  is  rather  a 
complicated  subject,  as  it  involves:  (i)  Prevention  of  fires. 
(2)  Putting  out  fires.  (3)  Rescue  of  persons  at  fires.  (4) 
Extinguishing  burning  clothing.  (5)  Avoidance  of  danger  from 
hot  or  molten  metal.  (6)  Avoidance  of  electric  shock;  and 
(7)  methods  to  prevent  explosions  of  gas  and  gunpowder. 

82 


FIRES  8$ 

Prevention  of  Fires 

Most  fires  result  from  carelessness.  It  would  seem  as  though 
very  few  people  would  be  foolish  enough  to  take  chances  in  this 
respect  but  hundreds  of  fires  are  caused  yearly  by  lack  of  common 
sense.  Throwing  matches  in  paper  baskets  is  not  safe.  Hot 
ashes  in  wooden  boxes  are  a  common  cause  of  fires.  Clothing 
hung  too  close  to  stoves  often  catches  fire  as  soon  as  it  dries. 
Fireplaces  unguarded  with  screens  frequently  cause  fires  from 
burning  cinders  which  snap  out  on  carpets  or  rugs.  Burning 
lamps  under  shelves  are  one  of  the  commonest  causes  of  fires. 
Defective  wiring  results  in  the  loss  of  many  homes. 

Putting  Out  Fires 

A  fire  almost  anywhere  may  be  easily  put  out  when  it  starts, 
whereas  a  very  few  moments'  delay  may  result  in  so  big  a  fire 
that  nothing  can  be  done  to  subdue  it  until  it  has  burned  every- 
thing inflammable  within  reach.  It  is  clear,  therefore,  that 
everyone  should  act  promptly  in  case  of  fire. 

At  first  a  fire  may  be  smothered  by  a  few  buckets  of  water  or 
by  throwing  blankets  or  woolen  clothing  upon  it.  Sand,  ashes 
or  dirt  will  all  quickly  smother  a  fire.  One  of  these  should 
always  be  used  instead  of  water  on  burning  oil,  as  water  will 
spread  the  oil  and  the  fire.  Anything  hanging  should,  when 
possible,  be  pulled  down  before  attempting  to  smother  the  fire 
in  it.  A  bucket  brigade  will  often  prove  valuable  in  putting  out 
a  fire.  This  should  consist  of  two  fines  of  men  from  the  nearest 
water  supply  to  the  fire.  The  men  in  one  line  pass  buckets, 
pitchers  or  anything  else  that  will  hold  water  from  one  to  another 
till  the  last  man  throws  the  water  on  the  fire.  He  returns  the 
buckets  to  the  water  supply  by  the  other  line.  Remember  that 
a  draft  will  fan  a  fire  and  therefore  keep  everything  closed  as 
much  as  possible  to  prevent  drafts. 

Rescue  of  Persons  at  Fires 

While  searching  through  a  burning  place  it  will  be  best  to  tie 
a  wet  handkerchief  or  cloth  over  the  nose  and  mouth.     Remem- 


84  INJURIES   DUE   TO  HEAT  AND   COLD 

ber  that  the  air  within  6  inches  of  the  floor  is  free  from  smoke.,  so 
when  unable  to  breathe  crawl  along  the  floor  with  the  head  low, 
dragging  anyone  you  have  rescued  behind  you.  Crawl  backward 
in  the  same  way  down  a  staircase  or  any  slope. 

Extinguishing  Burning  Clothing 

If  your  own  clothing  catches  on  fire  when  you  are  alone,  do 
not  run  for  help  as  this  will  fan  the  flames  and  make  them  burn 
fiercer. 

Lie  down  on  the  floor  and  roll  up  as  tightly  as  possible  in  a  rug, 
shawl,  overcoat,  blanket  or  other  woolen  cloth,  leaving  only  the 
head  out.  If  nothing  can  be  obtained  in  which  to  wrap  up,  lie 
down  and  roll  over  slowly,  at  the  same  time  beat  out  the  fire  with 
the  hands.  If  another  person's  clothing  catches  fire,  throw  him 
to  the  ground  and  smother  the  fire  with  a  coat,  blanket,  rug  or 
the  like. 

Avoidance  of  Danger  from  Hot  or  Molten  Metal 

Naturally,  only  persons  working  about  them  are  subject  to 
burns  from  these  sources.  Common  care  and  watchfulness  will 
do  much  to  prevent  them. 

Avoidance  of  Electric  Shock 

Some  general  rules  on  this  subject  are  given  under  the  heading 
"Electric  Shock." 

Methods  to  Prevent  Explosions  of  Gas  and  Gunpowder 

The  mixture  of  illuminating  gas  and  air  in  certain  proportions 
is  a  very  explosive  one.  This  is  also  true  of  the  mixture  of  cer- 
tain other  gases  with  air.  Any  unprotected  light  will  cause  an 
explosion,  so  do  not  enter  a  room  filled  with  gas  with  such  a 
light. 

In  handling  gunpowder  it  will  be  best  to  have  no  matches  in 
the  pockets,  and  lighted  cigars,  cigarettes,  pipes  and  lights  of 
every  description  are,  of  course,  extremely  dangerous. 

Symptoms  of  Burns  and  Scalds. — Severe  burning  pain.    De- 


BURNS   AND   SCALDS  85 

pending  on  depth  of  injury:  Reddening  of  skin;  formation  of 
blisters,  or  destruction  of  the  skin  and  some  of  the  tissues  be- 
neath it.     Shock,  severe  except  in  slight  injuries. 

Treatment. — When  the  skin  is  simply  reddened: 

Exclude  air  by  a  thin  paste  made  with  water  and  baking  soda, 
starch  or  flour.  Ordinary  vaselin  or  carbolized  vaselin,  olive 
or  castor  oil,  and  fresh  lard  or  cream  are  all  good.  One  of  the 
substances  mentioned  should  be  smeared  over  the  burned  part 
and  on  a  cloth  used  to  cover  it.  A  light  bandage  should  be  put 
on  to  hold  this  dressing  in  place.  The  services  of  a  doctor  will 
hardly  be  required  for  such  injuries. 

When  blisters  have  formed: 

Treatment  may  be  the  same,  but  if  the  blistering  is  very  exten- 
sive it  will  be  best  to  show  this  injury  to  a  doctor. 

Destruction  of  the  skin  and  some  of  the  tissues  beneath  it: 

Deep  burns  require  prompt  attention  from  a  physician. 
Before  his  arrival  they  may  be  treated  by  the  application  of 
the  dressing  which  has  been  described  or  like  a  wound.  A 
specially  valuable  dressing  material  for  such  burns,  or  in  fact  for 
all  burns,  is  picric  acid  gauze  which  is  wet,  in  steam  if  possible, 
and  is  then  applied  in  the  form  of  a  compress  which  should  be 
bandaged  in  place  like  any  other  compress.  Picric  acid  .may 
increase  burning  slightly  at  first  but  will  lessen  it  later.  Be  care- 
ful not  to  get  it  on  the  clothes  as  it  will  not  wash  out.  In  burns 
from  wax  or  gutta  percha  do  not  try  to  scrape  off. 
Always  remember  and  treat  shock. 

Besides  the  burns  which  have  been  described,  burns  are  fre- 
quently caused  by  strong  acid  and  alkalies.  The  symptoms  of 
burns  by  acids  and  alkalies  are  the  same  as  of  burns  caused  by 
heat.  With  either,  wash  off  as  quickly  as  possible;  best  under  a 
water  tap. 

Acids:  While  washing  injury,  have  lime-water  procured  or 
make  a  mixture  of  baking  soda  and  water  or  get  soapsuds  and 
apply  freely.  If  acid  has  entered  the  eye,  wash  it  as  quickly  as 
possible  with  water  and  then  with  lime-water.  Alcohol  is  what 
should  be  used  in  burns  from  carbolic  acid.  Pour  it  freely  on 
the  burn. 


86  INJURIES  DUE  TO  HEAT  AND  COLD 

Alkalies:  Wash  in  same  way  as  with  acid  burns.  Neu- 
tralize with  vinegar,  lemon  juice  or  hard  cider.  Lime  burns 
of  the  eye  should  be  washed  with  a  weak  solution  of  vinegar 
and  water  or  with  olive  oil.  With  both  acid  and  alkali  burns, 
after  neutralizing,  treat  like  other  burns.  In  severe  burns  of 
this  character  always  see  a  doctor,  and  when  either  acid  or  alkali 
has  entered  the  eye  secure  the  services  of  a  doctor  as  soon  as 
possible.     Treat  shock. 

The  subject  of  electric  sLock  is  treated  at  length  under  the 
proper  heading.  The  local  effect  produced  by  contact  with  an 
electric  current  is  a  burn.  Such  burns  except  those  due  to  a 
flash  are  deep.  It  is  easy  to  understand  this  as  contrary  to 
what  is  the  case  in  ordinary  burns,  which  affect  the  surface  first 
and  then  the  deeper  structures  of  the  body,  an  electric  burn  is 
due  to  a  current  of  electricity  which  passes  through  the  body 
burning  everything  in  its  course  to  nearly  an  equal  extent. 

Such  burns  are  very  slow  in  healing  but  they  are  not  as  painful 
as  other  burns  as  the  nerves  are  destroyed.  The  direct  current 
causes  much  severer  burns  than  the  alternating.  The  treat- 
ment of  electric  burns  is  the  same  as  for  other  burns. 

Warning. — In  all  burns,  whatever  the  cause,  use  care  in  remov- 
ing the  clothing.  When  the  clothing  sticks  to  a  burn,  do  not 
drag  it  off,  cut  around  the  part  that  sticks  and  soak  it  off  later 
with  oil.  Never  put  cotton  on  a  burn  as  it  will  stick  just  as  the 
clothing  does  and  it  will  be  almost  impossible  to  remove  it  later. 

SUNSTROKE  AND  HEAT  EXHAUSTION 
Sunstroke 

This  is  a  condition  produced  by  excessive  heat.  It  is  a  very 
dangerous  one. 

Cause. — Sometimes  due  to  direct  exposure  to  the  rays  of  the 
hot  summer  sun,  especially  when  the  air  is  moist. 

Most  commonly  due,  however,  to  somewhat  prolonged  ex- 
posure to  excessive  heat  while  working  indoors,  especially  if 
overfatigued. 


HEAT  EXHAUSTION  87 

Too  heavy  clothing  is  likely  to  help  to  cause  sunstroke,  and 
hats  and  caps  which  do  not  protect  the  head  from  the  sun  are 
dangerous. 

Drinking  any  kind  of  alcoholic  liquor  before  physical  exertion 
with  exposure  to  the  summer  sun  is  very  apt  to  result  in  sun- 
stroke. 

Prevention. — Avoidance  of  exposure  to  sun  in  middle  of  the 
day  in  summer.  The  best  possible  ventilation  of  workrooms  in 
summer,  and  avoidance  of  overfatigue  as  far  as  possible.  Light 
clothing  for  summer  and  light  head-gear  with  space  above  head 
for  ventilation.         Avoid  alcohol  before  exposure  to  sun. 

If  one  feels  the  first  symptoms  of  sunstroke  he  can  often  pre- 
vent actual  sunstroke  by  stopping  work,  finding  a  cool  place, 
lying  down,  bathing  face,  hands  and  chest  in  cold  water  and 
drinking  freely  of  cold  water. 

Symptoms. — Usually  before  actual  attack,  pain  in  the  head  and 
feeling  of  oppression.  Insensibility  complete.  Face  red.  Pupils 
dilated.  Skin  very  hot  and  dry.  No  perspiration.  Breath- 
ing labored  and  sighing.     Pulse  slow  and  full. 

Treatment. — Consists  in  reducing  temperature.  Send  for 
doctor.  Remove  at  once  to  cool  place.  Loosen  and  remove  as 
much  clothing  as  possible. 

Apply  cold  to  head  and  body.  To  do  this,  cold  water  or 
ice  should  be  rubbed  over  face,  neck,  chest  and  in  arm-pits.  Is 
still  better  to  put  patient  in  a  very  cold  bath  or  to  wrap  him  in 
sheets  wrung  out  in  cold  water  which  should  be  kept  wet  and 
cold  with  water  or  ice.  If  this  is  done,  must  rub  continually  to 
prevent  shock  and  to  bring  hot  blood  to  surface. 

When  consciousness  returns,  may  be  allowed  to  drink  cold 
water  freely. 

Cold  may  be  discontinued  when  consciousness  returns,  but 
if  skin  again  becomes  very  hot,  must  renew.     No  stimulants. 

Heat  Exhaustion 

Though  this  condition  is  caused  and  preven*  ^d  in  the  same 
ways  as  sunstroke,  it  is  really  quite  different  from  it.     Heat  ex- 


88  INJURIES   DUE   TO  HEAT  AND   COLD 

haustion  is  just  what  its  name  states — exhaustion  or  collapse 
due  to  excessive  heat. 

Symptoms. — Great  depression  and  weakness  but  not  really 
unconscious.  Face  pale  and  covered  with  clammy  sweat. 
Breathing  shallow.     Pulse  weak  and  rapid. 

Treatment. — Send  for  doctor.  Remove  to  cool  place  and 
have  patient  lie  down  in  most  comfortable  position  with  clothing 
loosened.  No  cold  externally,  but  may  sip  cold  water.  Stimu- 
lants, as  tea,  coffee,  aromatic  spirits  of  ammonia  or  small 
amount  of  brandy  or  whisky  with  a  good  deal  of  water. 

FROST-BITE  AND  FREEZING 
Frost-bite 

This  is  due  to  the  local  effect  of  cold  on  the  body,  parts  of 
which  freeze  much  as  do  many  other  objects.  The  parts  of  the 
body  which  are  most  liable  to  frost-bite  are  the  nose,  ears,  toes 
and  fingers. 

Cause. — Cold;  insufficient  clothing;  general  weakness  with 
poor  circulation  of  blood. 

Prevention. — Protection  of  the  body,  especially  the  exposed 
parts  named  above  with  sufficient  covering  when  it  is  necessary 
to  expose  yourself  to  intense  cold. 

Rubbing  of  any  part  of  the  body  which  becomes  very  cold 
in  order  to  increase  circulation,  or  the  supply  of  warm  blood  to 
the  cold  part. 

Symptoms. — In  intense  cold,  frost-bite  not  infrequently  occurs 
without  one's  knowing  it,  but  usually  the  ears,  fingers,  etc., 
become  painfully  cold  and  then  one  suddenly  realizes  that  they 
no  longer  have  any  feeling.  The  color  of  the  frozen  part  is  white 
or  grayish-white. 

Treatment. — Object:  To  gradually  bring  the  frozen  part  to 
its  natural  temperature. 

Rub  with  snow  or  cold  water.  Then  use  warm  water 
gradually. 

Warning. — The  use  of  heat  at  once  may  result  in  mortifica- 
tion or  death  of  the  frozen  part. 


FREEZING  89 

Freezing 

This  condition  is  produced  by  long  exposure  to  extreme  cold. 

Cause. — Extreme  cold.  Effect  of  which  is  increased  by  over- 
exertion, hunger,  alcoholic  liquors  and  insufficient  clothing. 

Prevention. — If  you  expect  to  be  exposed  to  extreme  cold, 
procure  warm  clothing  sufficient  in  amount  to  protect  you  from 
its  effects.  Do  not  attempt  a  long  journey  in  the  cold  without 
food  and  do  not  make  the  journey  so  long  that  you  are  likely 
to  have  to  stop  and  perhaps  lie  down  on  account  of  exhaustion. 
Do  not  drink  alcoholic  liquors,  for  though  they  give  a  tem- 
porary sense  of  warmth,  you  will  be  more  easily  overcome  by 
cold  after  this  effect  wears  off. 

If  caught  out  without  shelter  in  very  cold  weather  use  all 
your  energy  to  keep  moving.  Lying  down  under  such  cir- 
cumstances almost  always  results  in  freezing. 

Symptoms. — Surroundings  should  be  taken  into  account. 
Depression  is  so  great  that  appearance  of  patient  is  like  that  of 
a  dead  man. 

Treatment. — Object  is  gradually  to  restore  warmth  to  the 
body.  Take  patient  into  a  cold  room,  rub  limbs  toward  body 
with  rough  cloths  wet  in  cool  water;  increase  temperature  of 
room  if  possible.  This  should  be  done  gradually  and  cloths 
should  be  wet  in  warmer  and  warmer  water.  As  soon  as  patient 
can  swallow,  give  stimulant — coffee  or  tea  in  small  quantities, 
frequently  repeated  with  the  addition  of  a  little  whisky,  brandy, 
or  aromatic  spirits  of  ammonia. 

Patient  should  not  be  placed  before  an  open  fire  or  in  a  hot 
bath  until  circulation  has  become  active  in  cool  room.  You 
will  know  this  by  an  increased  force  of  the  pulse,  better  breath- 
ing and  more  warmth  and  color  in  the  skin. 

QUESTIONS 

1.  What  is  a  burn? 

2.  What  is  a  scald? 

3.  Why  are  burns  of  the  throat  and  windpipe  specially  dangerous? 

4.  What  are  the  general  principles  governing  the  prevention  of  fires? 
Suppose  a  fire  occurs,  how  would  you  try  to  put  it  out? 


go  INJURIES    DUE   TO   HEAT   AND    COLD 

5.  How  would  you  rescue  a  person  in  case  of  fire? 

6.  How  would  you  put  out  burning  clothing? 

7.  What  are  the  symptoms  of  burns  and  scalds? 

8.  Treatment:    Very  slight  burns  and  scalds;  where  blisters  have 
formed;  very  deep. 

9.  What  is  the  treatment  of  burns  from  strong  acids  and  alkalies? 

10.  What  can  you  say  of  burns  from  electricity? 

11.  What  is  the  difference  between  sunstroke  and  heat  exhaustion? 
Treatment  of  each? 

12.  What  is  frost-bite?     What  are  the  symptoms  of  frost-bite? 

13.  How  would  you  treat  frost-bite? 

14.  How  would  you  treat  freezing? 

PRACTICAL  EXERCISES 

Treatment  of  all  classes  of  wounds  and  burns,  with  methods  of 
checking  bleeding  by  the  class. 


CHAPTER  VII 

SUFFOCATION  AND  ARTIFICIAL  RESPIRATION : 

DROWNING;  ELECTRIC  SHOCK;  GAS 

POISONING;  HANGING 

Suffocation  is  caused  in  different  ways,  but  whatever  the  more 
remote  cause,  the  immediate  cause  is  always  interference  with 
the  supply  of  good  air  to  the  lungs,  and  with  the  escape  of  bad 
air  from  the  lungs. 

Some  knowledge  of  the  Respiratory  System  is  necessary  in 
order  that  the  subjects  of  this  chapter  may  be  understood. 

The  Respiratory  System 

This  system  consists  of  the  Nose  and  Mouth,  the  Windpipe 
and  the  Lungs. 

At  the  upper  end  of  the  windpipe  is  the  Larynx,  part  of  which 
we  know  as  the  prominent  Adam's  Apple  in  the  throat.  As  the 
larynx  is  in  front  and  the  gullet  is  behind,  food  and  water  passing 
to  the  latter  must  pass  over  the  upper  end  of  the  larynx  and  would 
enter  it  if  some  protection  were  not  provided.  This  is  afforded 
by  the  Epiglottis,  a  muscular  flap  or  curtain  which  falls  into 
position,  covering  the  upper  end  of  the  larynx  so  that  ordinarily 
food  does  not  enter  it.  Sometimes,  however,  the  epiglottis  does 
not  do  this,  especially  if  one  swallows  quickly  or  attempts  to 
talk  while  swallowing.  In  this  case  choking  results  from  food 
entering  the  larynx,  or,  in  common  words,  one  has  swallowed 
the  wrong  way.  The  attempt  to  give  food  or  water  to  an  un- 
conscious person  will  also  result  in  choking  him  because  his 
epiglottis  does  not  close. 

The  Lungs  are  two  soft,  spongy  structures,  each  of  which  is 
bag-like  in  shape  and  is  made  up  of  air  cells  with  many  blood- 

9i 


02  SUFFOCATION   AND    ARTIFICIAL   RESPIRATION 

vessels  surrounding  them;  they  are  sometimes  compared  to  a 
bunch  of  grapes.  The  lungs  are  hermetically  sealed  in  the  chest, 
so  that  when  the  cavity  of  the  chest  is  increased  or  diminished 
in  size,  the  same  effect  is  produced  on  the  lungs  themselves. 
Certain  muscles  are  of  great  importance  in  filling  and  emptying 
the  chest  and  lungs.  Ordinarily,  the  muscular  movement  con- 
sists simply  of  the  bellows  action  of  the  chest  and  the  up  and 
down  movement  of  the  diaphragm.  In  order  that  the  chest 
may  be  enlarged  to  its  greatest  capacity,  however,  some  of  the 
muscles  of  the  upper  extremity  must  also  take  part.  In  order 
that  they  may  do  so,  the  arms  are  raised  vertically  above  the 
head,  so  that  certain  muscles  attached  to  the  chest  wall  and  to 
the  upper  extremities  will,  when  the  latter  are  fixed,  raise  the 
ribs  and  thus  enlarge  the  chest.  The  chest,  too,  is  elastic  and 
direct  pressure  upon  it  will  diminish  its  size  and  so  force  the  air 
from  the  lungs. 

The  rate  of  respiration  is  16  per  minute. 

The  lungs  aerate  or  oxygenate  the  blood.  The  small  blood- . 
vessels  surrounding  the  air  cells  which  the  pure  air  breathed  in 
finally  reaches,  carry  dark  blood  which  has  lost  its  oxygen  in  the 
body.  This  blood  receives  oxygen  from  the  pure  air  and  returns 
to  the  heart  as  bright  arterial  blood.  The  air  which  is  expelled 
from  the  lungs  has  not  only  lost  its  oxygen  to  the  blood,  but  has 
also  received  certain  impurities  from  it. 

From  what  has  been  said  it  is  easy  to  understand  that  the  nose 
and  mouth  and  the  windpipe  are  simply  a  passageway  for  the 
air  going  to  and  coming  from  the  lungs.*  Naturally,  anything 
which  blocks  this  air  in  its  course  will  interfere  with  the  supply 
of  air  to  the  lungs  and  complete  blockage  will  result  in  early 
death  from  suffocation  or  asphyxiation. 

A  special  nerve  center  in  the  brain  governs  breathing  just  as 
other  similar  nerve  centers  govern  other  actions  of  the  body. 
Paralysis  of  this  center  will  stop  the  breathing  as  effectively  and 
completely  as  blocking  the  passage  of  the  air  to  the  lungs. 
Water  and  some  gases,  such  as  illuminating  gas,  will  also  prevent 
good  air  entering  the  lungs  and  will  thus  cause  suffocation. 

Symptoms  of  Suffocation. — At  first  the  lips,  the  face,  the 


ARTIFICIAL    RESPIRATION  93 

tongue  and  the  nails  get  blue  while  at  the  same  time  the  suffo- 
cated person  gasps  and  struggles  for  breath.  The  eyes  are 
staring  and  show  suffering.  Later  the  struggle  for  air  becomes 
greater  with  all  the  symptoms  mentioned  intensified.  Regular 
convulsions  come  on  in-  the  fight  to  get  good  air.  The  last  stage 
and,  of  course,  this  is  often  the  only  one  seen,  is  complete 
unconsciousness,  with  stoppage  of  the  breathing  or  an  occa- 
sional gasping  breath.  The  lips,  face,  tongue,  nails,  and  in 
fact  the  skin  of  the  whole  body  are  blue. 

Artificial  Respiration 

A  suffocated  person  cannot  get  the  good  air  into  his  own 
lungs  and  the  bad  air  out  but  fortunately  we  can  do  this  for 
him  by  certain  movements  imitating  breathing.  This  is  called 
artificial  respiration.  Before  beginning  it  loosen  all  clothing  so 
it  does  not  bind  the  body  anywhere.  Keep  everybody  away;  a 
suffocated  person  needs  all  the  good  air  he  can  get. 

Artificial  respiration  consists  of  alternate  movements  which 
diminish  the  size  of  the  elastic  chest,  and  then  by  relieving  pres- 
sure permit  it  to  regain  its  original  size. 

In  some  forms  of  artificial  respiration  the  size  of  the  chest  is 
also  increased  by  movements  which  put  on  the  stretch  the 
muscles  from  the  arms  to  the  chest. 

The  Schaefer  or  Prone  Pressure  Method  of  artificial  respiration 
is  now  generally  used,  though  the  older  Sylvester  Method  is  still 
very  popular.  The  advantages  of  the  Schaefer  Method  are  that 
by  it  a  greater  amount  of  air  is  gotten  into  the  lungs,  it  is  not 
necessary  to  hold  the  tongue  out  and  it  is  much  easier  for  the 
operator.  Unless  the  operator  is  extremely  rough  no  danger 
attends  its  practice.  Of  course,  if  either  of  the  arms  is  broken, 
the  Sylvester  Method  should  never  be  employed. 

In  the  Schaefer  Method  the  patient  is  laid  on  the  ground  face 
down.  The  arms  may  be  stretched  out  at  full  length  over  his 
head  or  one  arm  may  be  bent  so  the  forehead  rests  upon  it.  In 
either  case  the  face  must  be  placed  slightly  to  one  side  so  that 
the  ground  will  not  block  off  the  air  from  nose  and  mouth. 

As  soon   as  the  patient  is  in  proper  position,  the  operator 


94  SUFFOCATION  AND  ARTIFICIAL  RESPIRATION 

kneels  at  one  side,  or  astride  his  body  but  without  resting  his 
weight  upon  it.  The  palms  of  his  hands  are  placed  on  the  short 
ribs  across  the  small  of  the  back  with  the  thumbs  nearly  together. 
The  operator  by  letting  his  weight  fall  on  his  wrists  by  bending 
his  body  forward  decreases  the  size  of  the  chest  and  the  air  is 
expelled  from  the  lungs.  The  pressure  is  then  released  by  the 
operator  swinging  backward,  the  elastic  chest  springs  out  to#its 
original  size  and  the  air  is  drawn  into  the  lungs.  The  movement 
is  at  the  rate  of  12  to  14  a  minute.     Better  time  with  a  watch. 

The  Sylvester  Method. — Put  on  the  back.  The  tongue  must 
be  held  out  as  otherwise  it  will  fall  back  and  block  the  wind- 
pipe. Grasp  it  in  a  dry  cloth  or  pinchers.  Have  some  one  hold 
it  out  or  better  hold  it  out  by  a  bandage  or  rubber  band  over  the 
tongue  and  under  the  jaw.  Put  a  rolled  up  coat,  a  small  log  or 
something  else  of  the  same  shape  and  size  under  the  suffocated 
man's  shoulders.  This  will  straighten  his  windpipe.  Kneel 
just  above  patient's  head,  catch  both  his  arms  just  below  the 
elbows.  Draw  the  arms  outward  and  upward  gently  and  steadily 
and  hold  them  as  far  as  they  will  go  above  head  for  about  two 
seconds.  This  motion  opens  and  expands  the  chest  to  the  great- 
est possible  extent.  This  is  due  to  the  fact  that  certain  muscles 
are  attached  to  both  arms  and  ribs  and  when  the  arms  are  raised 
these  muscles  raise  the  ribs  and  so  enlarge  the  chest.  Then 
bring  the  arms  down  till  the  elbows  press  against  the  chest;  a 
little  pressure  will  diminish  the  size  of  the  elastic  chest  as  much  as 
possible.  Do  this  for  about  two  seconds.  Continue  these 
motions  about  fifteen  times  per  minute.  This  when  done  prop- 
erly is  hard  work  for  the  operator  and  he  should  be  relieved  by 
some  one  else  as  soon  as  he  grows  tired. 

Whatever  the  method  o(  artificial  respiration  used  it  should 
be  kept  up  for  at  least  an  hour  and  a  half. 

The  further  treatment  is  as  follows: 

Ammonia,  on  a  sponge  or  handkerchief  put  under,  but  not  on, 
the  patient's  nose  will  help  to  revive  him. 

At  the  same  time  that  one  or  two  persons  are  performing 
artificial  respiration,  without  interfering  with  them,  others 
should  cover  the  patient  with  a  dry  coat  or  blankets. 


DROWNING  95 

As  soon  as  the  patient  begins  to  breathe  himself,  but  not  be- 
fore, his  limbs  should  be  well  rubbed  toward  the  heart  under  the 
blankets.    This  will  help  to  restore  the  circulation. 

When  the  patient  is  partially  restored  he  may  have  a  chill 
and  vomit.  If  he  vomits  while  on  his  back  he  must  be  turned 
on  his  side  so  that  the  vomited  matter  will  not  enter  the  windpipe. 

He  should  afterward  be  put  to  bed  well  covered  and  sur- 
rounded with  hot  bottles.  The  windows  should  be  opened  so 
that  he  may  have  plenty  of  air. 

After  the  danger  is  over  the  patient  should  be  allowed  to  sleep 
quietly. 

He  will  feel  very  nervous  and  shaken  for  a  time  and  should  be 
given  absolute  rest  till  he  recovers  from  this  condition.  No 
food  except  hot  beef  tea  should  be  given  for  several  hours. 
Hot  coffee,  however,  is  useful  as  soon  as  the  patient  can  swallow 
and  retain  it. 

A  doctor  is  always  required  for  suffocation. 

While  the  pulmotor  is  now  often  used  to  advantage  in  place 
of  artificial  respiration,  you  must  never  wait  for  it. 

Warning. — If  the  breathing  stops  at  any  time  after  it  has 
once  begun  you  must  immediately  start  again  with  artificial 
respiration.  Piece  in  rather  than  do  it  all.  Let  the  patient 
breathe  himself  as  he  can.  You  are  to  make  the  necessary 
movements  when  he  cannot.     Maintain  same  rate. 

The  commoner  causes  of  suffocation  will  now  be  discussed  in 
more  detail.  Of  course  the  important  treatment  for  all  of  them 
is  artificial  respiration. 

Drowning 

Prevention. — This  will  be  spoken  of  under  two  heads:  i. 
Prevention  of  accidents  that  may  result  in  drowning.  2.  Rescue 
of  drowning  persons. 

1.  Prevention  of  Accidents  that  may  Result  in  Drowning. — 
Boating  accidents  are  frequent  in  all  parts  of  the  country  during 
the  summer  season.  In  order  to  do  your  part  to  prevent  them — 
Remember:    A  light  boat  is  not  intended  for  heavy  seas;  do  not 


96 


SUFFOCATION   AND   ARTIFICIAL   RESPIRATION 


RESCUE  METHODS 

Rescuer  should  not  go  into  the  water  unlet*  Necessary  but  should  use  a  Line,  Buoy  or  Boat 


Ice  Rescue 


Plate  XIV. — Drowning. 


RESCUE    OF  DROWNING   PERSONS  97 

change  seats  except  in  a  wide  and  steady  boat,  and  above  all 
things  do  not  put  yourself  in  the  class  of  idiots  who  rock  the  boat. 
In  case  you  are  thrown  into  deep  water  by  the  turning  over  of  a 
boat,  or  from  any  cause,  do  not  lose  your  presence  of  mind  even 
if  you  cannot  swim.  Remember  that  the  water  will  almost 
support  your  weight.  Allow  yourself  to  sink  low  so  your  nose 
is  just  above  the  water  and  support  yourself  by  a  hand  on  the 
boat.  Even  an  oar  under  the  chin  will  hold  you  up.  If  there 
is  nothing  which  will  help  to  support  you,  lie  flat  on  the  back 
with  the  arms  stretched  out.  Especially  in  salt  water  with 
light  clothing,  one  may  float  almost  indefinitely  in  this  position. 
To  do  so  it  is  necessary  to  keep  cool  if  the  water  or  spray  rises 
over  the  face  momentarily.  Throwing  up  the  head,  or  still 
worse  the  arms  or  legs  to  prevent  this  will  result  in  sinking. 

At  the  seashore,  unless  you  are  a  strong  swimmer,  do  not  go 
outside  the  life-lines  and  if  the  undertow  is  strong  be  careful  that 
you  do  not  walk  out  so  far  that  you  may  be  carried  off  your  feet. 

The  art  of  swimming  should  be  made  a  part  of  the  education 
of  every  boy  and  girl.  It  is  not  enough  to  know  how  to  swim  a 
few  strokes.  One  should  at  least  be  able  to  swim  for  a  few 
moments  while  dressed. 

Very  cold  water  and  very  long  swims  are  likely  to  result  in  the 
exhaustion  of  even  a  strong  swimmer  and  are  therefore  hazardous 
unless  a  boat  accompanies  the  swimmer. 

2.  Rescue  of  Drowning  Persons. — If  possible,  do  not  attempt 
to  rescue  a  drowning  person  in  deep  water  by  entering  the  water 
yourself.  The  best  interests  of  the  drowning  person  are  served, 
when  practical,  by  holding  out  or  throwing  something  into  the 
water  on  which  he  can  support  himself  till  he  can  be  pulled  ashore 
or  reached  in  a  boat.  In  case  a  person  has  fallen  into  deep 
water  near  the  shore  take  an  oar,  a  pole,  a  rope  or  even  your 
coat  and  hold  it  out  so  the  drowning  person  may  grasp  it.  Life 
preservers,  boxes,  boards  or  logs  may  also  be  thrown  into  the  water 
close  to  the  person  drowning.  As  has  been  stated  above,  a 
small,  floating  object  is  quite  sufficient  to  sustain  a  person's 
weight  in  the  water. 

If  the  person  in  danger  of  drowning  is  so  far  from  the  shore 
7 


98  SUFFOCATION   AND   ARTIFICIAL  RESPIRATION 


BREAKING  DEATH  GRIPS 


3.  When  Rescuer  is  Clutched  around 
the  Body  or  Arms 


2.  Artificial  Respiration  (B) 


Plate    XV. — Drowning. 


RESCUE    OF   DROWNING   PERSONS  99 

that  the  methods  just  spoken  of  cannot  be  used  you  must  enter 
the  water  to  rescue  him.  Take  off  as  much  of  your  clothing  as 
possible.  It  is  especially  necessary  to  rid  yourself  of  your  shoes. 
If  you  are  not  a  strong  swimmer  it  will  be  much  better  to  support 
yourself  with  a  life  preserver,  a  board,  box,  or  the  like,  when 
swimming  out  to  the  drowning  person. 

Always  take  care  not  to  allow  a  drowning  person  to  grasp  you 
for  this  will  very  likely  result  in  the  loss  of  both  your  lives.  If 
he  succeeds  in  seizing  you  it  will  be  safest  to  allow  yourself  to 
sink  or  to  strike  him  a  blow  in  the  face  in  order  to  make  him 
loosen  his  hold.  There  is  no  cruelty  in  such  a  blow;  it  may  be 
his  only  salvation.  Unconscious  persons  are  in  fact  rescued 
much  more  easily. 

The  methods  of  breaking  death  grips  are  illustrated  and  should 
be  adopted  in  proper  cases. 

Always  approach  a  drowning  man  from  behind.  A  practical 
method  of  rescue  is  to  grasp  his  hair  or  collar  with  your  left 
hand  and  his  right  shoulder  with  your  right  hand  keeping  him 
at  arm's  length  with  his  mouth  and  nose  just  above  the  water, 
then  "tread  water."  As  soon  as  you  can,  seize  his  right  wrist 
and  pull  it  behind  his  head,  then  take  a  few  strokes  to  get  on 
your  back,  at  the  same  time  pull  the  person  you  are  rescuing  on 
your  chest  and  start  to  swim  backward  to  shore.  Swim  as  low 
as  possible,  with  your  face  and  that  of  the  drowning  person 
just  out  of  the  water. 

To  rescue  a  person  who  has  broken  through  the  ice:  You 
should  first  tie  a  rope  around  your  body  and  have  the  other  end 
tied,  or  held,  on  shore.  Then  secure  a  long  board,  or  a  ladder, 
crawl  out  on  this  or  push  it  out  so  that  the  person  in  the  water 
may  reach  it.  If  nothing  can  be  found  on  which  you  can  support 
your  weight  do  not  attempt  to  walk  out  toward  the  person  to 
be  rescued,  but  lie  down  flat  on  your  face  and  crawl  out  as  by 
doing  this  much  less  weight  bears  at  any  one  point  on  the  ice 
than  in  walking. 

Symptoms. — Are  of  course  those  of  suffocation.  In  addi- 
tion a  frothy  fluid  is  often  noticed  in  the  mouth  and  nose  and  the 
body  is  cold. 


IOO  SUFFOCATION   AND    ARTIFICIAL   RESPIRATION 

Treatment. — Artificial  respiration  and  other  measures  just 
as  described  under  Artificial  Respiration.  If  there  is  mud 
or  water  in  the  mouth,  first  clean  it  out  by  a  handkerchief 
wrapped  around  the  first  finger.  If  the  Schaefer  Method  is 
used,  you  may  proceed  with  artificial  respiration  at  once.  If 
the  Sylvester  is  employed,  before  giving  it,  it  will  be  well  after 
cleaning  what  mud  and  water  you  can  from  the  mouth  to  turn 
the  patient  on  his  face,  clasp  hands  around  his  waist,  raise  -him 
by  the  middle  and  hold  up  for  a  few  seconds  in  order  that  water 
may  drain  from  throat  and  lungs.  Don't  waste  time  before 
beginning  artificial  respiration. 

Electric  Shock 

The  more  general  use  of  electricity  is  making  accidents  due  to 
it  more  common  year  by  year.  Even  now  the  third  rail  and  the 
live  wire  are  responsible  for  many  injuries  and  deaths. 

The  ordinary  trolley  wire  carries  a  current  of  about  500  volts, 
and  incandescent  and  arc-light  currents  run  from  2500  to  3000 
volts.  The  passage  of  these  powerful  currents  through  the  body 
causes  dangerous  shock  or  even  death. 

Prevention. — The  third  rail  is  always  dangerous,  so  avoid  it. 

Swinging  wires  of  any  kind  may  somewhere  in  their  course 
be  in  contact  with  live  wires,  so  they  should  not  be  touched. 

Electric  wires  must  always  be  carefully  avoided. 

Symptoms. — Are  due  to  paralysis  of  the  nerve  center  in  the 
brain  which  governs  breathing  and  in  consequence  are  those  of 
suffocation. 

Sudden  loss  of  consciousness  occurs  when  a  powerful  electric 
current  passes  through  the  body. 

The  breathing  may  be  entirely  stopped  or  it  may  be  shallow 
and  only  occasional. 

Weak  pulse  as  the  electric  current  affects  the  heart  as  well  as 
the  breathing  apparatus. 

If  hands  are  in  contact  with  a  live  wire,  may  not  be  able  to 
release  them  at  first 

Burns  of  hands  or  other  parts  of  the  body  in  contact. 


ELECTRIC   SHOCK  IOI 

The  direct  current  causes  severe  burns  but  is  not  so  dangerous 
to  life.  The  alternating  while  more  dangerous  to  life  does  not 
cause  as  severe  burns.  Low-voltage  currents,  especially  alter- 
nating currents,  cause  many  deaths. 

Little  difficulty  should  be  experienced  in  making  out  cause  of 
injury. 

Treatment. — First,  rescue;  second,  treat. 

i.  Rescue. — In  some  cases  it  will  be  possible  to  shut  off  cur- 
rent and  this  should  always  be  done  if  it  can  be  done  quickly. 

A  person  in  contact  with  wire  or  rail  carrying  an  electric 
current  will  transfer  current  to  rescuer  if  the  latter  puts  him- 
self in  the  line  of  passage  of  current.  Therefore,  he  must  not 
touch  the  body  of  a  person  touching  a  live  wire  or  a  third  rail 
unless  his  own  body  is  thoroughly  insulated.  Naturally  too, 
he  must  not  himself,  in  attempting  to  aid  the  injured  person, 
bring  any  part  of  his  own  body  in  contact  with  the  live  wire 
or  other  apparatus  carrying  the  electric  current.  Moreover, 
he  must  act  very  promptly  for  the  danger  to  the  patient  is 
much  increased  the  longer  the  electric  current  is  permitted  to 
pass  through  his  body.  If  possible,  the  rescuer  should  insulate 
himself  by  covering  his  hands  with  a  rubber  coat,  rubber 
sheeting,  or  even  several  thicknesses  of  dry  cloth.  Silk  is  a 
good  non-conductor.  In  addition  he  should,  if  possible,  com- 
plete his  insulation  by  standing  on  a  dry  board  or  a  thick  piece 
of  dry  paper,  or  even  on  a  dry  coat.  Rubber  gloves  and  shoes 
or  boots  are  still  safer,  but  they  cannot  usually  be  procured 
quickly.  If  a  live  wire  is  under  a  patient  and  the  ground  is 
dry  it  will  be  perfectly  safe  to  stand  upon  it  and  to  pull  him 
off  the  wire  with  the  bare  hands.  But  they  should  touch  only 
his  clothing  and  this  must  not  be  wet. 

A  live  wire  lying  on  a  patient  may  with  safety  be  flipped  off 
with  a  dry  board  or  stick. 

In  removing  the  live  wire  from  the  patient,  or  the  patient  from 
the  wire,  do  this  with  one  motion  as  rocking  him  to  and  fro  on 
the  wire  will  increase  shock  and  burn. 

A  live  wire  may  be  safely  cut  by  an  axe  or  hatchet  with  a  dry 
wooden  handle  and  the  electric  current  may  be  short-circuited 


102  SUFFOCATION   AND   ARTIFICIAL  RESPIRATION 


HOW  TO  RESCUE  PERSON  FROM  CONTACT  WITH  ELECTRIC  CURRENT 
(When  possible  the  rescuers  should  Stand  on  Dry  Wood  or  Cloth) 


5.  With  Garment  or  Cloth 


Plate  XVI. — Electric  shock. 


GAS   POISONING  103 

by  dropping  a  crowbar  or  poker  on  the  wire.  These  should 
be  dropped  on  the  side  from  which  the  current  is  coming  and 
not  on  the  further  side  as  the  latter  will  not  short-circuit  the 
current  before  it  has  passed  through  the  patient's  body.  Drop 
the  metal  bar,  do  not  place  it  on  the  wire  or  you  will  then  be 
made  a  part  of  the  short  circuit  and  receive  the  current  of  elec- 
tricity through  your  body. 

2.  How  to  Treat. — Some  cases  of  electric  shock  from  powerful 
currents  are  hopeless  from  the  beginning.  It  is  impossible  to 
tell  this  at  first,  however,  and,  therefore,  an  attempt  should 
always  be  made  to  save  the  life  of  patient  by  prompt  treatment. 
The  treatment  is  artificial  respiration. 

It  is  possible  for  those  who  have  received  an  electric  shock 
which  does  not  render  them  unconscious  to  perform  artificial  re- 
spiration of  a  sort  on  themselves  and  so  to  recover  without  further 
treatment.  This  is  done  by  raising  the  upper  extremities  and 
lowering  them  again  and  again  while  taking  deep  breaths. 

Burns  from  electricity  should  be  treated  like  other  burns. 

Gas  Poisoning 

Illuminating  gas  is  so  generally  employed  that  this  form  of 
suffocation  is  common.  Very  similar  effects  are  produced  by 
other  poisonous  gases. 

Causes. — The  common  gases  which  produce  suffocation  are 
illuminating  gas,  coal  gas  from  furnaces  or  stoves  and  smoke 
often  mixed  with  different  gases.  Poisoning  from  ammonia 
fumes  is  seen  now  much  more  frequently  than  formerly,  as  at 
present  ammonia  is  so  largely  used  in  refrigerating  and  ice- 
making  machinery. 

Prevention. — Naturally  is  dependent  on  the  cause.  Extra- 
ordinary care  must  be  taken  wherever  much  gas  is  mixed  with 
the  air. 

Leaks  in  gas  pipes  should  be  promptly  repaired.  Be  careful 
in  turning  off  gas  to  make  sure  that  gas  is  actually  shut  off. 

It  is  dangerous  to  leave  a  gas  jet  burning  faintly  when  you  go 
to  sleep,  as  it  may  go  out  if  pressure  in  gas  main  becomes  less, 


104  SUFFOCATION   AND   ARTIFICIAL  RESPIRATION 


RESCUE  METHODS  (Continued) 


I.  With  Wooden  Handled  Tool 


HOW  TO  GIVE  ARTIFICIAL  RESPIRATION 


2.  Artificial  Respiration  (B) 


1.  Showing  Different  Degrees 
from  Charring  to  Reddening 
of  Skin 


2.  Dressing  for  Burn  of  Forearm 


Plate  XVII. — Electric  Shock. 


GAS   POISONING  105 

id  if  pressure  is  afterward  increased,  gas  may  escape  into 
iom  in  large  amount. 

Coal  gas  will  escape  through  red-hot  cast  iron,  and  very  big 
•es  in  such  stoves  are  dangerous,  especially  in  sleeping  rooms. 
Charcoal  burned  in  open  vessels  in  tight  rooms  is  especially 
mgerous. 

In  sewers  and  wells  it  is  customary  to  lower  a  lighted  candle  or 
rch;  if  this  does  not  burn  it  is  certain  the  air  is  so  impure  that 
le  cannot  live  in  it. 

Symptoms. — Are  those  of  Suffocation  but  in  those  slightly 
[ected  are  not  so  severe:  Headache,  dizziness,  sick  at  stomach 
id  vomiting,  very  sleepy,  weak,  rapid  breathing,  fast  pulse. 
Treatment. — Rescue  person  overcome  promptly  and  take 
m  where  there  is  plenty  of  good  air.  To  rescue  an  uncon- 
ious  person  in  a  place  filled  with  gas,  move  quickly  and  carry 
m  out  without  breathing  yourself.  Take  a  few  deep  breaths 
fore  entering  and  if  possible  hold  breath  while  in  the  place, 
•equently  less  gas  will  be  found  near  floor.  So,  one  may  be 
►le  to  crawl  where  it  would  be  dangerous  to  walk.  The  treat- 
ent  is  artificial  respiration. 

In  those  slightly  affected,  artificial  respiration  is  unnecessary, 
romatic  spirits  of  ammonia,  one-half  teaspoonful  in  half  glass  of 
iter.  Repeat  if  necessary  four  times  at  15-minute  intervals, 
nelling  salts  to  nose.  Baking  soda,  a  teaspoonful  in  one-half  a 
ass  of  water  will  settle  the  stomach  and  cause  belching  of  gas. 
t  gas  works,  effervescing  phosphate  of  soda  is  often  provided  and 
perhaps  the  best  remedy  instead  of  baking  soda  though  if  it  is 
)t  at  hand  it  would  be  a  bad  mistake  to  wait  to  procure  it  in- 
ead  of  using  baking  soda.  The  dose  of  phosphate  of  soda  is 
10  teaspoonfuls  in  one-half  glass  of  water.  In  gas  works  too, 
dss  beer  or  plain  soda  water  are  sometimes  used  instead  of  phos- 
mte  of  soda.  The  value  of  breathing  in  vinegar  from  a  sponge 
id  of  the  current  of  air  from  an  electric  fan  is  also  generally 
cognized. 

If  a  person  with  gas  poisoning  in  this  stage  is  fairly  strong  he 
ould  be  walked  around,  two  persons  supporting  him  with  his 
ms  around  their  necks.    If  feet  drag  this  shows  he  is  too  weak 


106  SUFFOCATION  AND   ARTIFICIAL  RESPIRATION 

for  this  treatment  and  he  should  be  placed  lying  down.     Then 
if  he  is  not  breathing  well,  start  artificial  respiration. 
Even  in  mild  cases  it  is  much  safer  to  send  for  a  doctor. 

Hanging 

Hanging  is  a  common  means  of  suicide.  As  the  rope  cuts  off 
the  air  to  and  from  the  lungs  the  result  is,  of  course,  suffocation. 

Treatment. — Cut  down  and  remove  the  rope  from  the  neck. 
Artificial  respiration. 

QUESTIONS 

i.  What  is  the  cause  of  suffocation? 

2.  Of  what  does  the  respiratory  system  consist? 

3.  How  may  the  supply  of  air  to  the  lungs  be  interfered  with? 

4.  Symptoms  of  suffocation? 

5.  What  is  Artificial  Respiration? 

6.  What  should  you  do  for  a  suffocated  person  besides  performing 
the  movements  of  artificial  respiration? 

7.  Drowning.     Prevention?     Rescue?     Treatment? 

8.  How  weak  a  current  will  cause  dangerous  electric  shock? 

9.  Electric  shock;  prevention;  symptoms? 

10.  What  would  you  do  to  rescue  a  person  in  contact  with  a  live  wire? 

11.  How  would  you  treat  him  after  he  had  been  rescued? 

12.  How  would  you  treat  a  burn  due  to  electricity? 

13.  Gas  Poisoning.     Prevention?     Treatment? 

14.  What  would  you  do  for  a  person  who  had  attempted  suicide  by 
hanging? 

PRACTICAL  EXERCISES 

Each  member  of  the  class  should  be  required  to  give  artificial 
respiration  by  the  Schaefer  and  Sylvester  Methods. 


CHAPTER  VIII 

UNCONSCIOUSNESS  OR  INSENSIBILITY.    POISONING 

UNCONSCIOUSNESS 

Unconsciousness,  is  lack  of  consciousness.  One  who  is  un- 
conscious knows  nothing  of  his  surroundings,  or  of  what  is 
happening.  There  are,  however,  different  degrees  in  this  con- 
dition. That  is  to  say,  the  same  causes  when  not  exerted  to 
so  great  an  extent  may  only  cause  partial  unconsciousness,  which 
may  be  recovered  from  without  going  further,  or  may  be 
followed  by  total  unconsciousness.  Insensibility  and  uncon- 
sciousness are  two  different  names  for  the  same  thing.  Per- 
haps no  condition  which  the  first-aid  student  may  be  called 
upon  to  treat  may  prove  more  puzzling  than  this.  Unconscious- 
ness may  result  from  a  number  of  different  causes,  and  in  order  to 
give  the  best  treatment  one  should  determine  first  what  the 
cause  is.  Always  make  an  earnest  effort  to  do  this  by  taking 
the  surroundings  into  account  as  well  as  by  examination  of  the 
patient. 

Suppose,  however,  that  you  are  unable  to  determine  the  cause 
of  unconsciousness.  At  least  make  very  sure  that  it  is  due 
neither  to  a  poison,  to  bleeding  nor  to  sunstroke,  for  each  of 
these  demands  immediate  special  treatment,  or  to  suffocation 
for  which  you  would,  of  course,  give  artificial  respiration. 
Then,  unless  it  is  necessary  to  give  the  special  treatment,  if 
the  patient  is  pale  and  weak  have  him  lie  down  with  his  head 
low  and  warm  and  stimulate  him  in  every  possible  way;  on  the 
contrary,  if  the  face  is  red  and  pulse  is  very  strong,  while  the 
position  for  the  patient  should  also  be  lying  down,  the  head 
should  be  raised.  No  stimulants  should  be  given  in  the 
latter  condition  and  cold  water  should  be  sprinkled  on  face 
and  chest. 

107 


108  UNCONSCIOUSNESS    OR   INSENSIBILITY.      POISONING 

A  doctor  is  always  needed. 

The  common  causes  of  unconsciousness  are:  Bleeding,  sho 
electric  shock,  sunstroke,  heat  exhaustion,  freezing,  fainti: 
fits,  apoplexy  and  injury  to  the  brain,  and  certain  poisons. 

The  six  causes  which  head  this  list  have  already  been  c 
cussed  at  length  and  are  only  mentioned  here  so  that  the  fir 
aid  student  may  find  in  one  place  all  the  commonest  cau 
of  unconsciousness.  Likewise  and  for  the  same  practical  reas< 
poisoning  by  alcohol,  opium  and  its  preparations,  and  carbc 
acid  are  discussed  here. 

i.  Bleeding. — Ordinarily  you  will  see  the  blood  in  a  woui 
Even  in  internal  bleeding  from  the  lungs  or  stomach,  blood 
often  coughed  up  or  vomited  as  the  case  may  be. 

2.  Shock. — You  learn  an  injury  has  been  received,  or  th< 
is  other  evidence  of  injury. 

3.  Electric  Shock. — Should  be  no  difficulty  in  finding  out  t 
cause. 

4  and  5.  Sunstroke  and  Heat  Exhaustion. — In  very  1 
weather.  In  sunstroke  the  patient  is  so  hot  that  his  skin  see: 
to  be  burning.  With  heat  exhaustion,  the  skin  is  cold  a 
clammy  like  in  a  faint  which  it  resembles  closely. 

6.  Freezing. — Should    experience    no    difficulty. 

7.  Fainting 

Cause. — A  lack  of  blood  to  the  brain.  Some  persons  oft 
faint.  Fainting  is  common  in  any  form  of  weakness,  as  wh 
recovering  from  a  severe  illness.  Some  people  faint  at  the  sig 
of  blood. 

Prevention. — A  person  who  has  not  yet  recovered  his  f 
strength  after  an  illness  or  injury  should  be  careful  not  to  over 
physically.  Persons  who  faint  from  trivial  causes  require  t 
advice  and  treatment  of  a  physician.  Remember  that  fainti 
may  be  due  to  a  hemorrhage,  and  if  there  is  any  reason  to  susp< 
that  the  patient  is  bleeding,  examine  him  carefully  and  che 
the  bleeding  promptly. 

Symptoms. — Usually  occurs  in  overheated,  crowded  plac 


FITS 


IO9 


itient  becomes  paler  and  paler  and  finally  sinks  to  the  floor 
iconscious.  Unconsciousness  is  partial  or  complete.  Face  is 
le,  frequently  covered  with  cold  perspiration.  Pupils  are 
tural.  Breathing  is  shallow  and  sighing.  Pulse  is  weak  and 
pid.  No  other  cause  for  unconsciousness. 
Treatment. — Sometimes  can  prevent  fainting  by  having 
rson  who  feels  faint  double  over  so  that  head  is  between  knees, 
this  does  not  prove  effective  at  once  do  not  continue.  Air, 
Decially  cold  air,  and  cold  water  often  prevent  actual  fainting 
len  a  person  feels  faint.  If  patient  has  actually  fainted,  put 
n  in  lying-down  position  with  his  head  lower  than  the  rest  of 
5  body,  so  that  brain  will  receive  more  blood.  Loosen  clothing, 
Decially  around  neck,  for  same  purpose.  Open  windows,  if 
cessary,  and  keep  away  crowd  so  that  patient  may  get  plenty 
air.  Sprinkle  face  and  chest  with  cold  water.  Smelling 
ts  or  ammonia  to  nose.  Rub  limbs  toward  body.  Do  not 
ow  patient  to  get  up  until  fully  recovered.  May  give  stimu- 
it  when  patient  has  so  far  recovered  that  he  is  able  to  swallow. 

8.  Fits 

rhese,  which  usually  occur  in  young  adults,  begin  gen- 
Hy  by  the  afflicted  person  falling  to  the  ground,  perhaps 
:h  a  cry,  and  then  going  through  all  sorts  of  convulsive  move- 
nts, throwing  the  arms  and  legs  about,  jerking  the  head, 
ling  the  eyes,  and  foaming  at  the  mouth,  and  perhaps  biting 
s  tongue.  There  should  be  little  difliculty  in  telling  what  is 
!  matter  at  this  stage,  but  afterward,  unconsciousness 
nes  on. 

.f  you  can  see  or  find  out  about  the  convulsion  you  will  at 
:e  know  what  the  trouble  is.  In  the  unconscious  stage  this 
lot  so  easy.  Disarranged  clothing,  foam  at  the  mouth,  and 
;  bitten  tongue  should  be  looked  for. 

n  the  unconscious  stage,  it  is  only  necessary  to  allow  the 
lent  to  rest  quietly.  Do  not  try  to  prevent  the  convulsions 
holding  him.  Put  him  on  the  ground,  or  floor,  or  somewhere 
1  where  he  cannot  injure  himself  by  threshing  about  and  put 


IIO         UNCONSCIOUSNESS   OR  INSENSIBILITY.      POISONING 

a  piece  of  wood  covered  with  a  handkerchief  in  his  mouth  so 
that  he  cannot  bite  his  tongue. 

9.  Apoplexy  and  Injury  to  the  Brain 

Apoplexy  is  due  to  the  bursting  of  a  diseased  blood-vessel  in 
the  brain.  The  escaping  blood  presses  on  the  nerve-centers 
and  this  causes  the  symptoms.  An  injury  of  the  brain  also  in- 
jures these  centers,  so  from  a  first-aid  standpoint  the  symptoms 
and  treatment  of  apoplexy  and  brain  injuries  may  be  considered 
together. 

Symptoms. — Apoplexy  often  comes  on  suddenly.  In  brain 
injury,  may  see  and  learn  of  injury  to  head.  In  brain  injury 
there  may  be  hemorrhages  from  nose,  ears,  mouth  and  eyes. 
Unconsciousness,  complete.  Face:  Red  in  apoplexy j  pale 
in  injury.  Pupils,  large  and  frequently  unequal  in  size.  Eye- 
balls insensitive  to  touch.  Breathing,  snoring/  Pulse:  full 
and  unusually  slow.  Paralysis  usually  on  one  side  of  body. 
Test  by  raising  arm  or  leg.  If  paralyzed,  will  drop  absolutely 
helpless. 

Treatment. — Send  for  doctor  at  once.  Rest  and  quiet,  in  a 
dark  room  if  possible.  In  lying-down  position  with  head  and 
shoulders  raised  on  a  pillow.  Ice  or  cold  cloths  to  head.  Hot 
bottles  to  limbs.     No  stimulants. 

10.  Alcoholic  Poisoning 

Alcoholic  poisoning  or  intoxication  represents  the  final  stage  in 
acute  drunkenness;  that  is,  the  common  spere. 

Symptoms. — Perhaps  evidence  of  intoxication.  Unconscious- 
ness, partial  or  complete;  frequently  able  to  arouse  patient  to 
some  extent.  Face  sometimes  flushed  and  bloated,  or  may  be 
pale.  Skin  cool  and  may  be  moist.  Pupils  natural  or  large. 
Eyeballs  red,  but  not  insensitive  to  touch.  Breathing  about  as 
usual  when  in  deep  sleep.  Pulse,  usually  rapid  and  weak,  but 
may  be  slow.     May  be  strong  odor  of  liquor.     No  paralysis. 

Warning. — Insensibility  from  alcohol  and  apoplexy  are  more 
often  mistaken  one  for  the  other  than  are  any  other  forms  of 
unconsciousness.     The    most    important    symptoms   in    which 


POISONING  BY    OPIUM  III 

they  differ  are  the  state  of  the  pupils,  the  sensitiveness  of  the 
eyeballs  and  paralysis.  The  odor  of  liquor  on  the  breath  is 
of  little  value,  because  a  person  with  apoplexy  may  have  been 
drinking. 

Treatment. — If  any  doubt  whether  drunkenness  or  apoplexy, 
always  treat  for  apoplexy  and  be  particularly  careful  not  to  make 
patient  vomit,  as  this  will  cause  more  bleeding  into  brain. 

In  drunkenness,  if  able  to  arouse  sufficiently,  give  emetic — ■ 
mustard  and  water  or  luke-warm  water  are  usually  easily  pro- 
cured. Afterwards  strong  coffee  or  aromatic  spirits  of  ammonia. 
Hot  bottles  around  patient.  Rub  limbs  toward  body  to  increase 
circulation. 

ii.  Poisoning  by  Opium  or  some  Preparation  of  Opium, 
usually  Morphine 

Cause. — These  poisons  are  often  taken  in  attempts  at  suicide 
but  a  good  many  soothing  syrups  and  quieting  mixtures  contain 
opium  or  one  of  its  numerous  preparations  and  as  children  are 
very  susceptible  to  these  drugs  cases  of  poisoning  due  to  them  are 
not  uncommon. 

Prevention. — As  with  all  poisons,  no  opium  mixture  should 
be  allowed  to  fall  into  the  hands  of  anyone  who  will  not  know 
what  it  is  and  its  dangers.  Soothing  syrups  should  never  be 
given  to  children.  All  drugs  containing  opium  are  dangerous 
unless  prescribed  by  a  doctor. 

Symptoms. — May  find  person  has  taken  opium  or  may  find 
bottle  which  contained  poison.  Unconsciousness  which  comes 
on  gradually  and  finally  becomes  complete.  Face  red  at  first, 
finally  dark  purple.  Lips  bluish.  Pupils  very  small,  like  pin 
heads.  Breathing  full  and  slow  at  first,  gradually  slower  and 
shallow.  Pulse,  slow  and  full,  afterwards  weak.  Possibly  smell 
of  laudanum  on  breath.  Symptoms  that  should  be  especially 
noted  are  pin-head  pupils,  breathing  and  that  patient  is  first 
very  sleepy  and  then  becomes  unconscious. 

Treatment. — Give  an  emetic:  mustard  and  water;  salt  and 
water;  luke-warm  water  alone  in  large  quantities.  Exact 
dose  is  unimportant,  give  in  large  quantities  and  repeat  if  pro- 


112  UNCONSCIOUSNESS   OR  INSENSIBILITY.      POISONING 

fuse  vomiting  does  not  occur.  (May  have  difficulty  in  getl 
emetic  to  work.)  Plenty  of  strong  coffee.  Try  to  arouse  pati 
by  speaking  loudly  and  threatening  him,  also  slap  with 
towel.  Walk  up  and  down,  two  persons  supporting  him.  M 
stop  this  if  patient  is  weak  or  you  will  exhaust  him.  Then 
on  back.  Artificial  respiration  will  then  be  required  more  ti 
anything  else.     Stimulants. 

12.  Carbolic-acid  Poisoning 

Cause. — This  poison  is  easily  obtained  and  is  often  used 
attempts  at  suicide.  On  account  of  its  strong  odor  it  is  rai 
taken  accidentally. 

Prevention. — Like  that  of  other  poisons.  As  it  produces  1 
burns  it  should  never  be  applied  to  the  skin. 

Symptoms. — You  may  find  poison  has  been  taken  or  the  bo 
which  contained  poison.  Vomiting  and  great  pain.  S 
covered  with  cold  sweat.  If  severe  case,  unconsciousn 
usually  followed  promptly  by  death.  Strong  carbolic  acid  i 
very  rapid  poison.  May  almost  always  know  by  the  str< 
smell  of  carbolic  acid.  Lips,  tongue  and  mouth  are  bur: 
white  by  pure,  and  black  by  impure  carbolic  acid. 

Treatment. — Rinse  mouth  with  pure  alcohol.  If  grown  j 
son,  should  swallow  three  or  four  tablespoonfuls  of  alec 
mixed  with  an  equal  quantity  of  water.  (Use  other  remec 
for  children.)  Follow  this  in  five  minutes  with  two  tablespo 
fuls  of  Epsom  salts  dissolved  in  a  little  water.  Though  not 
good,  lime-water  may  be  used  to  rinse  mouth,  several  glas 
of  it  being  also  swallowed.  Three  or  four  raw  eggs  may  be  giv 
or  castor  or  sweet  oil.    Stimulants  always,  and  keep  warm. 

In  burns  of  the  skin  from  carbolic  acid,  use  alcohol  to  neuti 
ize  the  acid.     Afterwards  treat  like  other  burns. 

POISONING 

Alcohol,  opium,  and  its  preparations,  and  carbolic  acid  hi 
already  been  discussed. 


POISONING  113 

Any  substance  taken  into  the  body  which  will  cause  death  is  a 
poison.  But  only  poisons  which  are  swallowed  will  be  con- 
sidered here. 

Prevention. — Accidental  poisoning  may  be  prevented  to  a 
very  great  extent  by  never  taking  any  medicine  which  is  not 
properly  labeled,  and  by  putting  poisons,  when  they  must  be 
kept  on  hand,  in  a  safe  place  under  lock  and  key. 

Symptoms  and  Evidence  of  Poisoning. — The  symptoms  vary 
with  the  special  poison.  But  there  is  certain  evidence  which 
indicates,  in  the  majority  of  cases,  that  a  poison  has  been  taken. 
Sudden,  severe  and  unexpected  illness  in  any  one  after  eating, 
drinking  or  taking  medicine  may  be  due  to  poison. 

Possibly  the  poisoned  person  has  been  melancholy  and  has 
talked  of  suicide.  Bottles,  glasses  or  the  like  in  which  some  of 
the  poison  remains  may  be  nearby. 

Frequently  a  person  who  has  taken  poison  intentionally, 
becomes  frightened  and  is  only  too  glad  to  tell  some  one  that  he 
has  poisoned  himself  and  what  poison  he  has  used.  In  accidental 
poisoning  the  patient  is,  of  course,  willing  to  tell  all  he  knows 
in  reference  to  the  poison. 

If  a  number  of  persons  who  have  eaten  the  same  food  become 
seriously  ill  after  a  meal,  it  is  almost  certain  they  are  suffer- 
ing from  poison,  probably  decayed  food  or  the  so-called  pto- 
maine poisoning. 

Treatment. — Delay  is  likely  to  prove  fatal  in  poisoning  so 
whatever  is  done  must  be  done  promptly.  Always  send  for  a 
doctor  at  once  but  do  not  wait  for  his  arrival.  An  emetic  is  not 
the  best  treatment  for  every  poison.  But,  nevertheless,  it  should 
always  be  given  if  you  do  not  know  what  poison  has  been  taken 
and  the  proper  antidote. 

Running  the  finger  down  the  throat  or  drinking  a  large  quan- 
tity of  warm  water  will  usually  cause  vomiting. 

Good  emetics  are: 

Mustard  and  water  or  salt  and  water,  a  teaspoonful  of  either 
in  a  glass  of  luke-warm  water.  One  or  two  teaspoonfuls  of  the 
wine  or  syrup  of  ipecac  are  also  good  and  usually  easily  pro- 
cured. Do  not  waste  time  in  getting  the  exact  dose,  however, 
8 


114         UNCONSCIOUSNESS   OR  INSENSIBILITY.      POISONING 

and  repeat  if  profuse  vomiting  does  not  result.     Drink  luke-warm 
water  between  attacks  of  vomiting. 

The  following  table,  giving  the  antidotes  for  special  poisons 
may  be  consulted  with  benefit  if  it  is  at  hand.  No  attempt 
should  ordinarily  be  made  by  the  first-aid  student  to  learn  it  by 
heart. 

Poisons  are  of  Three  Kinds 

(A)  Corrosive  poisons  produce  instant  burning  effect  on  all 
parts  touched  by  them  so  there  is  staining  of  lips  and  mouth  and 
burning  pain  in  mouth,  throat  and  stomach;  straining  and 
vomiting;  also  perhaps  suffocation  and  always  shock. 

(B)  Irritant  Poisons. — Such  poisons  irritate  but  do  not  cor- 
rode parts  they  touch.  No  staining;  metallic  taste;  burning  of 
mouth  and  throat  and  in  stomach,  straining,  vomiting  and 
purging.     Shock. 

(C)  Nerve  poisons  do  not  stain.     Two  classes: 

1.  Narcotics.     Produce  deep  sleep  and  insensibility. 

2.  Convulsants.  Produce  convulsions,  twitching,  delirium 
and  suffocation.  (Some  poisons  are  both  irritant  and  nerve 
poisons.) 

(A)  Corrosive  Poisons. — Those  which  stain  and  for  which  an 
emetic  is  best  not  given.  'Strong  acids:  Sulphuric  (oil  of  vitriol) ; 
hydrochloric  (spirits  of  salt);  nitric  (aqua  fortis).  Strong 
alkalies:  Caustic  soda,  potash  and  lime. 

Treatment. — 

i.  Neutralize  poison. 

2.  Dilute  poison  and  soothe  corroded  parts. 

3.  Stimulants. 

(1)  If  acid,  to  neutralize  give  alkalies  as  plaster  from  ceiling, 
magnesia,  baking  soda  or  even  soap.  If  alkalies,  to  neutralize 
give  vinegar,  lemon  or  orange  juice. 

(2)  To  dilute  and  soothe  for  both  acids  and  alkalies  give  large 
quantities  of  oil,  any  vegetable  or  animal  oil,  such  as  olive,  salad, 
sardine,  linseed,  castor  or  cod  liver  oil;  also  water,  milk,  flour 
and  water,  or  eggs  beaten  up. 


QUESTIONS  115 

(3)  Stimulants:     Strong  tea  and  coffee,  ammonia  or  alcohol. 

(B)  Irritant  Poisons. — Those  which  do  not  stain  and  for  which 
an  emetic  is  given.  Tartar  emetic,  blue  stone,  Paris  Green,  lead, 
corrosive  sublimate  (antiseptic  tablets)  phosphorus  and  arsenic 
(rat  poison  and  other  vermin  killers) ;  poisonous  plants. 

Treatment. — 

1.  Emetic. 

2.  Dilute  poison  and  soothe  parts. 

3.  Stimulants. 

2.  To  dilute  and  soothe:  As  in  corrosive  poisons.  But  no 
oil  in  phosphorus  poisoning. 

3.  Stimulants:  As  above. 

(C)  Nerve  Poisons. — Do  not  stain  and  require  an  emetic. 

(1)  Sleep  producers:  Opium,  morphine,  laudanum,  paregoric, 
soothing  syrups,  powders,  chlorodyne.  At  first  very  sleepy, 
later  insensibility,  pupils  of  eye  very  small,  breathing  deep,  slow 
and  snoring,  face  first  flushed  then  livid,  breath  may  smell  of 
the  poison. 

Treatment. — 

1.  Emetic. 

2.  Keep  awake,  strong  coffee.  Slap  with  wet  towel.  Walk 
up  and  down  supporting  on  each  side.  Stop  this  if  weak  and  put 
in  lying-down  position. 

3.  Artificial  respiration. 

(2)  Convulsants.  Strychnine,  belladonna,  prussic  acid,  etc. 
Strychnine  is  far  more  common.  Is  found  in  some  vermin 
killers. 

Treatment. — In  all  these  poisons  must  work  very  quickly. 
Emetic.  Do  not  wait  for  it  to  be  prepared  but  tickle  back  of 
throat  with  finger  and  keep  it  there  till  vomiting  occurs.  Artifi- 
cial respiration  if  breathing  stops. 

QUESTIONS 

1.  What  is  unconsciousness? 

2.  To  what  causes  is  it  most  commonly  due? 

3.  Explain  how  you  would  make  out  the  cause? 


Il6  UNCONSCIOUSNESS   OR  INSENSIBILITY.      POISONING     ' 

4.  If  you  were  unable  to  do  this  what  would  you  do? 

5.  Fainting;  cause;  prevention;  symptoms  and  treatment? 

6.  Symptoms  and  treatment  of  fits? 

7.  Alcoholic  poisoning,  with  what  is  it  often  confused  and  what 
should  you  do  to  prevent  such  a  mistake? 

8.  Treatment  of  alcoholic  poisoning. 

0.  Apoplexy  and  injury  to  the  brain,  symptoms  and  treatment? 
10.  Symptoms  and  treatment  of  opium  poisoning, 
n.  Symptoms  and  treatment  of  carbolic-acid  poisoning. 

12.  What  would  make  you  think  a  person  had  been  poisoned? 

13.  What  different  classes  of  poisons  are  there  and  the  treatment  of 
each  class? 

14.  What  would  you  do  if  you  thought  a  poison  had  been  taken  but 
could  not  find  out  what  the  poison  was? 

PRACTICAL  EXERCISES 

A  general  review  which  should  include  practical  problems  in  first  aid 
of  general  interest  and  of  interest  to  the  special  class.  As  an  example 
of  a  problem  of  the  former  kind  the  following  is  given:  You  are  walking 
along  a  country  road  and  find  a  man  who  has  been  thrown  from  his 
horse.  He  is  unconscious,  his  right  thigh  and  left  arm  are  broken. 
Take  care  of  him.  . 

Questions  should  always  be  asked  in  connection  with  the  problems 
so  that  the  instructor  may  make  sure  the  members  of  the  class  clearly 
understand  what  they  are  doing  and  the  reason  for  each  step. 


CHAPTER  IX 

COMMON  EMERGENCIES 

i.  Cramp  or  Colic.  2.  Diarrhea.  3.  Constipation.  4. 
Nausea  and  Vomiting.  5.  Hiccough.  6.  Chill  from 
Exposure.  7.  Nervous  Attacks.  8.  Croup.  9.  Neu- 
ralgia of  Face.  10.  Tooth- ache.  ii.  Ear-ache.  12. 
Styes.  13.  Sunburn.  14.  Prickly  Heat.  15.  Poison 
Ivy  or  Oak.  16.  Mosquito  Bites.  17.  Chilblains.  18. 
Corns.  19.  Poisonous  Plants,  especially  Mushrooms. 
20.  Home  Medicines. 

Care  of  cases  of  slight  illness  usually  falls  on  the  women  of  the 
family.  For  them,  therefore,  it  is  no  less  necessary  to  know  how 
to  meet  these  common  household  emergencies,  as  they  are  some- 
times called,  than  it  is  to  know  how  to  take  care  of  injuries.  In 
fact,  it  often  proves  to  be  much  more  important. 

A  word  of  warning  must  be  said  here,  however.  One  may  be 
of  the  very  greatest  service  if  she  learns  how  to  prevent  and  to 
treat  these  minor  illnesses.  On  the  other  hand,  if  this  knowledge 
results  in  her  dosing  her  family  with  drugs  great  harm  is  sure  to 
follow.  This  is  a  responsibility  she  has  no  right  to  take.  Every 
one  employs  a  lawyer  to  look  after  questions  of  property.  Health 
questions  are  certainly  of  more  vital  interest,  and  to  settle  them 
a  trained  man  is  no  less  necessary  and  in  this  case  this  is  the 
doctor. 

Our  country  has  suffered  more  from  amateur  doctoring  espe- 
cially with  patent  medicines  than  any  other.  The  dangers  of 
such  medicines  should  be  clearly  understood.  They  are  made 
up  for  the  million  and  they  cannot  fit  any  one  person  any  more 
than  one  dress  would  fit  a  million  women.  An  ill-fitting  dress 
may  do  no  harm  except  to  one's  pride  but  the  delicate  cells  which 

117 


Il8  COMMON  EMERGENCIES 

make  up  the  human  body  cannot  be  insulted  in  this  way  with- 
out serious  consequences.  It  is  true  some  manufacturers  of 
patent  medicines  claim  to  fit  their  medicine  to  each  case  but  so 
far  as  my  observation  goes  this  is  never  done,  cheap  clerks  with 
no  knowledge  of  medicine  actually  deciding  what  is  required. 
Even  supposing  this  were  not  the  case,  such  treatment  would 
depend  on  the  statements  of  the  person  seeking  it  and  no  repu- 
table doctor  pretends  to  be  able  to  tell  what  is  the  matter  unless 
he  is  given  the  opportunity  to  see,  question  and,  if  necessary, 
examine  the  patient.  Patent  medicines,  too,  are  made  up  for 
profit,  the  expenses  connected  with  selling  them  are  very  great 
so  you  can  never  get  the  value  of  the  money  you  spend  on  them. 
Moreover,  many  of  these  preparations  contain  dangerous  drugs 
through  which  in  perfect  innocence,  the  whisky,  morphine  or 
cocaine  habits  may  be  acquired.  Still  further  while  patent  medi- 
cines may  give  a  temporary  feeling  of  relief,  often  through  the 
alcohol  which  they  contain,  one  taking  them  may  be  really  grow- 
ing worse  all  the  time  so  that  finally  when  a  doctor  is  consulted 
it  is  too  late  for  him  to  do  anything. 

The  best  advice  which  can  be  given,  therefore,  is  to  confine 
yourself  to  the  simple  remedies  mentioned  here  and  to  caring 
only  for  real  emergencies,  calling  a  doctor  promptly  if  necessary. 
This  will  result  in  saving  health,  money  and  time. 

i.  Cramp  or  Colic 

As  everyone  knows,  abdominal  cramp  is  a  severe  pain  in  the 
abdomen  which  comes,  lets  up,  and  comes  again.  The  cramps 
may  follow  one  another  very  rapidly  or  there  may  be  some  time 
between  them. 

Cause. — Common  cramp  is  due  to  a  spasm  of  the  intestines 
caused  by  indigestible  food,  or  by  cold,  especially  when  over- 
heated in  hot  weather.  More  uncommon  causes  are  appen- 
dicitis and  gall  or  kidney  stones. 

Prevention. — As  one  of  the  commonest  causes  of  cramp  is 
indigestible  food  you  should  be  careful  to  avoid  this;  unripe  fruit 
and  partially  spoiled  food  are  most  dangerous.     Even  in  very 


DIARRHEA  119 

hot  weather  the  abdomen  should  be  lightly  covered,  especially 
at  night,  and  if  one  is  subject  to  cramps  they  will  often  be  pre- 
vented by  the  use  of  an  abdominal  band. 

Prevention  of  cramp  due  to  the  other  causes  which  have  been 
mentioned  is  too  complicated  a  subject  for  discussion  except  in 
medical  books. 

Symptoms. — Severe  cramping  pain  in  the  abdomen  and  shock 
in  severe  cases.  If  shock  is  severe,  it  is  well  to  conclude  that 
something  more  serious  than  intestinal  cramp  is  present. 

Treatment. — A  hot  bottle  placed  on  the  abdomen  or  rubbing 
it  will  often  give  relief.  Soda  mint  tablets,  or  even  better,  hot 
water  with  a  little  syrup  of  ginger  should  be  taken.  Indigestible 
matter  may  be  gotten  rid  of  by  vomiting  or  by  a  cathartic,  such 
as  a  compound  cathartic  pill,  salts,  or  a  Seidlitz  powder.  If 
shock  is  severe  always  send  for  a  doctor. 

2.  Diarrhea 

Is  caused  just  as  is  the  common  type  of  abdominal  cramp  and 
naturally  its  prevention  is  the  same. 

Treatment. — The  object  of  treatment  is  to  expel  the  indi- 
gestible matter  from  the  bowels.  This  is  best  accomplished  by 
giving  tV -grain  doses  of  calomel,  15  minutes  apart  until  6  doses 
are  taken,  and  by  following  this  after  8  or  10  hours  by  a  Seidlitz 
powder  or  a  dose  of  Epsom  Salts. 

For  diarrhea  with  considerable  cramping  pain  a  teaspoonful 
of  syrup  of  ginger  in  f  of  a  glass  of  water  should  be  given  after 
each  passage.  For  painless  diarrhea,  20  grains  of  subnitrate  of 
bismuth,  3  times  daily,  is  a  good  and  safe  remedy.  For  children 
a  dose  of  castor  oil  should  be  given  instead  of  the  remedies  which 
have  been  mentioned. 

The  diet  is  also  of  great  importance  in  diarrhea  and  nothing 
should  be  eaten  which  will  furnish  new  food  for  fermentation  or 
will  irritate  the  digestive  organs. 

Milk  in  small  quantities  is  the  best  food  for  both  grown-ups 
and  children.  Boiling  the  milk  is  the  wiser  plan  unless  it  is 
certain  that  it  is  very  fresh  and  pure. 


120  COMMON   EMERGENCIES 

If  the  remedies  mentioned  do  not  cure  the  diarrhea  it  is  much 
safer  to  consult  a  doctor.  There  are  any  number  of  so-called 
cholera  cures  on  the  market  but  the  majority  contain  opium  in 
some  form  and  are  therefore  dangerous,  especially  for  children. 

3.  Constipation 

Constipation  may  be  prevented  in  most  people.  Persons 
inclined  to  be  constipated  should  be  careful  to  eat  bulky  food; 
oatmeal  and  the  like  are  especially  good  as  they  irritate  the  intes- 
tines slightly.  They  should  also  drink  plenty  of  water.  Many 
persons  too  suffer  from  chronic  constipation  because  they  are 
careless  and  do  not  establish  regular  habits.  Instead  of  always 
taking  cathartics  one  who  suffers  from  chronic  constipation  should 
try  to  get  rid  of  the  cause  of  this  condition.  To  do  this  the 
advice  of  a  doctor  is  required. 

For  acute  constipation,  six  -rV-grain  doses  of  calomel  at  inter- 
vals of  15  minutes,  taken  at  night,  and  a  Seidlitz  Powder  or  a  dose 
of  Epsom  Salts  the  next  morning  are  excellent  remedies. 

4.  Nausea  and  Vomiting 

These  are  also  usually  due  to  indigestible  food  but  may  be 
caused  by  dyspepsia  or  nervousness. 

Treatment. — When  due  to  indigestible  food,  several  large 
drinks  of  luke-warm  water  will  usually  cause  free  vomiting  and 
will  wash  out  the  stomach,  which  is  very  desirable.  The  further 
treatment  is  the  same  whatever  the  cause.  Patient  should  lie 
down  in  cool  place.  Hot  applications  to  abdomen;  cloths  wrung 
out  in  hot  water  or  a  mustard  plaster.  A  soda  mint  tablet  or  a 
little  baking  soda  will  usually  stop  both  nausea  and  vomiting 
and  in  other  cases  sucking  small  lumps  of  ice  will  be  found 
efficacious. 

5.  Hiccough 

Is  usually  due  to  overeating  and  indigestion.  It  is  caused  by 
a  spasmodic  contraction  of  the  diaphragm,  the  great    muscle 


CROUP  121 

which  separates  the  chest  from  the  abdomen.  This  is  the  reason 
that  holding  the  breath  as  long  as  possible  will  usually  cure  it  as 
the  air  in  the  chest  forces  the  diaphragm  down  so  it  cannot  con- 
tract. Drinking  a  large  glass  of  water  in  small  sips  without  tak- 
ing a  breath  has  exactly  the  same  effect.  The  reason  that  a 
scare  stops  hiccough  sometimes  is  because  this  causes  the  patient 
to  take  a  long  breath.  If  none  of  these  methods  is  successful, 
vomiting  by  removing  the  irritating  material  from  the  stomach 
will  almost  always  cure  the  hiccough. 

6.  Chill  from  Exposure 

When  one  is  exposed  to  the  cold,  especially  to  cold  rain  or  snow, 
or  falls  into  cold  water  he  will  often  become  what  is  commonly 
called  "chilled  through." 

Cause. — This  condition  is  due  to  the  fact  that  the  cold  con- 
tracts the  blood-vessels  of  the  skin,  driving  the  blood  to  the 
interior  of  the  body.     This  gives  one  the  sensation  of  chilliness. 

Symptoms. — You  are  chilly.  The  lips  become  blue  and  the 
teeth  chatter. 

Treatment. — Remove  the  clothing,  if  possible,  and  put  into 
a  warm  bed,  covering  the  patient  warmly.  Two  or  three  hot 
bottles  will  warm  the  bed  well.  Rubbing  his  limbs  and  body 
will  also  bring  the  blood  to  the  surface  and  so  help  to  cure  the 
chill.  Hot  drinks  should  also  be  given.  Hot  tea,  hot  coffee, 
hot  milk,  and  hot  lemonade,  are  all  good. 

7.  Nervous  Attacks 

These  are  usually  a  mild  form  of  hysteria.  The  patient  has 
a  fit  of  shivering  and  complains  of  feeling  cold  and  upset.  The 
treatment  is  exactly  the  same  as  that  described  for  a  chill  from 
exposure. 

8.  Croup 

This  is  a  children's  disease  due  to  a  spasm  of  the  muscles  of  the 
upper  air-passages.     Children  often  have  what  is  called  a  croupy 


122  COMMON   EMERGENCIES 

cough  whenever  they  catch  cold.  This  is  a  hard  ringing  cough 
which  is  distressing  but  not  particularly  alarming  except  to 
parents,  who  fear,  perhaps  from  previous  experience,  that  an 
attack  of  true  croup  is  coming  on.  Lighting  the  light,  talking 
to  the  child,  reading  to  him,  or  telling  a  favorite  story  will  often 
result  in  the  attack  passing  off  and  in  the  child  becoming  drowsy 
and  finally  going  to  sleep. 

True  croup  is  much  more  alarming  though  not  often  danger- 
ous. The  child  has  the  ringing  cough  and  croupy  crow  and 
becomes  partially  suffocated  because  sufficient  air  does  not  enter 
the  lungs.  The  face  becomes  bluish  and  the  child  struggles  to 
get  its  breath. 

Treatment. — Send  for  a  doctor  but  do  not  wait  for  him  to 
arrive.  Such  a  child  should  at  once  be  given  an  emetic.  A 
teaspoonful  of  syrup  of  ipecac  is  best  for  this  purpose  followed 
by  a  drink  of  warm  water.  Then  cloths  wrung  out  in  as  hot 
water  as  the  child  can  stand  should  be  put  about  the  throat  and 
on  the  chest.  These  should  be  covered  with  a  piece  of  dry  cloth, 
or,  better,  of  oiled  silk  if  this  can  be  procured.  Change  these 
cloths  as  soon  as  they  begin  to  grow  cool,  but  do  nothing  further 
till  the  physician  arrives. 

9.  Neuralgia  of  the  Face 

Some  people  are  very  subject  to  neuralgia  or  pain  in  some  of 
the  nerves  of  the  face.  This  neuralgia  may  be  due  to  the  irrita- 
tion of  a  bad  tooth  or  to  some  other  irritation  less  easily  found, 
but  unfortunately  in  certain  people  the  cause  cannot  be  dis- 
covered. Persons  who  suffer  from  attacks  of  neuralgia  should 
always  consult  a  doctor,  but  such  attacks  often  come  on  sud- 
denly when  no  physician  can  be  obtained. 

Treatment. — Hot  applications  are  usually  better  than  cold 
ones  and  should  always  be  tried  first  unless  the  patient  knows 
from  previous  experience  that  cold  will  do  him  more  good. 
Either  hot  water,  or  cloths  wrung  out  in  hot  or  cold  water  may 
be  used.  Painting  the  painful  part  with  the  ordinary  menthol 
stick  relieves  many  people.     Some  are  benefited  by  the  irritation 


TOOTH- ACHE  1 23 

produced  by  rubbing,  and  pressure  on  the  painful  nerve  often 
gives  temporary  relief.  If  the  neuralgia  is  due  to  a  bad  tooth 
the  proper  emergency  treatment  of  the  tooth  will  frequently 
cure  the  neuralgia. 


10.  Tooth-ache 

The  prevention  of  decay  of  the  teeth  consists  in  the  removal 
of  all  food  from  between  them,  for  such  food  ferments  quickly 
thus  producing  an  acid  which  corrodes  the  teeth.  The  teeth 
should  be  brushed  night  and  morning  and  after  each  meal  if 
possible.  Dental  floss  should  also  be  used  if  difficulty  is  experi- 
enced in  dislodging  particles  from  between  the  teeth  with  a 
brush. 

Tooth-ache  is  due  to  decay  and  to  food  entering  the  cavity  of 
a  tooth  where  it  decomposes  and  causes  irritation  and  pain  of 
the  sensitive  nerves. 

Treatment. — If  the  cavity  can  be  reached,  it  should  be  cleaned 
out  and  afterwards  something  put  in  it  to  deaden  the  nerve.  To 
clean  it,  twist  a  very  small  piece  of  cotton  around  a  toothpick  or 
fine  knitting-needle  and  put  it  in  the  hole  in  the  tooth,  twisting 
it  around  and  around  so  as  to  clean  out  the  cavity  thoroughly. 
After  this  has  been  done  another  small  piece  of  cotton  should 
be  dipped  in  oil  of  cloves  and  then  gently  put  into  the  cavity 
on  the  end  of  the  tooth-pick  or  needle.  If  the  cavity  cannot 
be  reached,  the  aching  tooth  must  be  treated  by  an  application 
to  its  gum  between  the  latter  and  the  cheek.  A  small  piece  of 
absorbent  cotton  soaked  in  spirits  of  camphor  is  excellent  for 
this  purpose.  The  burning  caused  by  it  is  severe,  but  it  will 
usually  cure  the  tooth-ache.  Tooth-plasters  may  be  used  in  the 
same  way.  Of  course,  these  are  merely  emergency  measures, 
and  because  they  cure  the  tooth-ache  for  the  time  being,  this 
does  not  mean  that  it  is  safe  for  you  to  go  on  without  the  services 
of  a  dentist.  You  should  realize  that  unless  you  have  proper 
attention,  decay  will  -go  on  in  the  tooth,  you  will  have  tooth- 
ache again,  and  will  finally  lose  the  tooth. 


124 


COMMON   EMERGENCIES 


ii.  Ear-ache 

This  is  particularly  common  in  children,  and  may  be  due  to 
bad  teeth,  to  disease  of  the  throat,  or  to  trouble  in  the  ear  itself. 

Treatment.— The  teeth  should  always  be  examined,  and  if  a 
cavity  is  found  it  should  be  treated  in  the  way  already  described. 
If  nothing  is  found  the  matter  with  the  teeth  or  treatment  of 
bad  teeth  fails  to  relieve  the  pain  in  the  ear,  it  will  be  necessary 
to  try  to  stop  the  pain  by  treating. the  ear  itself.  Cloths  wrung 
out  in  hot  water,  changed  as  soon  as  they  begin  to  grow  cold, 
or  a  hot-water  bottle  put  on  the  face  covering  the  outside  of 
the  ear  will  often  cure  ear-ache.  Another  method  is  to  heat 
a  cloth  very  hot  and  to  pour  a  few  drops  of  alcohol  on  its  center 
and  then  apply  this  over  the  ear  so  that  the  alcohol  fumes  will 
enter  the  ear.  Alcohol  on  a  hot  shovel  is  even  better,  but  harder 
to  use.  Heating  sweet  oil  just  hot  enough  not  to  burn  and  then 
putting  a  few  drops  in  the  ear  and  introducing  a  small  plug  of 
absorbent  cotton  should  be  tried  if  the  other  remedies  mentioned 
do  not  prove  effective. 

Severe  ear-ache  always  demands  the  services  of  a  doctor  as 
disease  of  the  inner  ear  may  result  in  perforation  of  the  ear- 
drum, and  permanent  deafness,  which  may  often  be  prevented 
by  a  physician  if  treated  promptly. 

12.  Styes 

Styes  are  an  inflammation  at  the  edge  of  the  eye-lid,  usually 
of  the  small  glands  there.  As  they  commonly  indicate  ill  health 
or  an  error  of  vision,  a  doctor  should  be  consulted  in  order  that 
he  may  give  treatment  which  will  prevent  styes  appearing  again. 
The  pain  from  a  stye  may  be  diminished  to  a  considerable  extent 
by  wetting  a  cloth  with  water  as  hot  as  can  be  borne  and  putting 
it  on  the  eye.  If  matter  appears,  a  doctor  should  make  the  small 
cut  necessary  to  permit  it  to  escape. 

13.  Sunburn 

This  may  vary  from  a  slight  redness  bf  the  skin  to  a  very 
severe  burn.     People,  especially  those  with  delicate  skins,  may 


POISON  IVY  OR  OAK  1 25 

avoid  a  good  deal  of  needless  discomfort  by  protecting  themselves 
when  exposed  to  the  bright  summer  sun.  That  there  is  anything 
healthy  in  tan  or  sunburn  is  a  wholly  false  idea.  Protection  is, 
of  course,  afforded  by  hats  and  clothing  which  shade  the  face 
and  body  from  the  sun.  Wetting  the  face,  on  the  contrary, 
especially  with  salt  water,  is  likely  to  cause  very  severe  sunburn. 
Any  toilet  powder  will  protect  the  face  from  the  sun's  rays  to 
some  extent. 

The  treatment  consists  of  soothing  applications.  Cold  cream 
and  other  toilet  creams  are  good.  Vaselin  and  carbolized  vaselin 
are  also  generally  used.  An  excellent  application  and  one  easily 
prepared  is  one  part  lime  water  to  three  parts  almond  or  olive 
oil.  These  remedies  should  be  put  on  immediately  after  washing 
the  sunburned  skin.  Frequent  washing  will,  however,  make 
things  worse  instead  of  better. 

14.  Prickly  Heat 

Is  the  well-known  irritating  disease  of  the  skin  produced  by 
heat.  It  is  most  common  in  children  whose  skins  are  very 
delicate  and  occurs  in  hot  weather,  not  infrequently  being  due 
in  part  to  too  much  clothing.  It  may  be  prevented  to  a  con- 
siderable extent,  even  in  the  tropics,  by  not  exercising  so  as  to 
cause  sweating  and  by  avoiding  heating  drinks.  A  good  talcum 
powder  frequently  applied  also  does  much  to  prevent  this  annoy- 
ing disease  of  the  skin. 

When  prickly  heat  is  severe  the  skin  should  be  bathed  with  a 
mixture  of  one  part  alcohol  to  three  of  water,  afterward  dusting 
with  talcum  powder.  Lime  water  with  about  two  drops  of 
carbolic  acid  to  the  ounce  is  an  excellent  application  for  prickly 
heat,  as  the  carbolic  acid  numbs  the  nerves  of  the  painful,  irri- 
tated skin.  One  of  these  applications  should  always  be  put  on 
after  bathing. 

15.  Poison  Ivy  or  Oak 

These  plants  which  so  commonly  cause  skin  poisoning  belong 
to  the  sumac  family.  There  are  two  varieties.  One,  the  ivy,  is  a 
creeper  or  climbing  plant  with  broad  leaves,  sometimes  slightly 


126  COMMON  EMERGENCIES 

notched,  arranged  in  dusters  of  three.  The  other,  the  oak,  is 
a  shrub  or  small  tree  with  oval  pointed  leaves  arranged  in  clusters 
of  from  seven  to  thirteen  on  a  common  stalk.     Both  have  berries. 

These  plants  cause  poisoning  in  almost  everyone  who  touches 
them  and  some  people  can  hardly  go  near  them  without  being 
poisoned.  Early  in  the  disease  a  person  may  carry  the  poison 
from  one  part  of  his  body  to  another  by  scratching.  Very  rarely 
one  person  infects  another. 

Prevention. — Is,  of  course,  avoiding  poison  ivy  and  oak. 
Remember  there  is  no  certainty  that  because  at  one  time  you 
have  handled  these  plants  without  injury  the  same  will  be  true 
on  another  occasion. 

Symptoms. — Are  those  of  a  severe  inflammation  of  the  skin. 
This  appears  on  the  exposed  parts,  usually  the  hands  and  the 
arms  and  face.  The  skin  becomes  much  inflamed  and  swollen, 
blisters  form  and  sometimes  the  inflammation  is  so  severe  that 
matter  forms.  There  may  be  loss  of  the  upper  layers  of  the  skin 
and  a  red  weepy  surface.  The  pain,  itching  and  discomfort  are 
severe. 

Treatment. — If  severe,  a  doctor  should  be  consulted  promptly. 
A  very  good  and  simple  remedy  is  a  wash  of  boracic  acid  solu- 
tion in  water  followed  by  ordinary  zinc  ointment  smeared  on  the 
inflamed  skin.  This  should  be  covered  with  a  thin  cloth  only, 
as  a  thicker  one  will  cause  heating.  Lime  water  for  the  wash 
and  carbolized  vaselin  for  the  ointment  are  fairly  good.  The 
ointment  should  be  washed  off  daily  with  the  wash,  the  inflamed 
skin  dried  and  the  ointment  reapplied.  In  making  the  boracic 
acid  solution,  put  enough  in  the  water  so  that  some  deposits 
on  the  bottom,  you  cannot  get  too  strong  a  solution.  A  good 
old  country  remedy  is  made  by  putting  a  cent  in  vinegar  and 
using  this  wash  frequently. 

1 6.  Mosquito  Bites 

These  injuries  are  usually  of  slight  importance,  but  it  is  well 
to  remember  that  in  certain  places  malaria  is  caused  by  the 
bites  of  mosquitoes,  and  that  to  prevent  this  disease  mosquito 
nets  and  other  means  of  protection  against  them  should  be  used. 


CORNS  127 

Ammonia,  hartshorn,  is  the  best  remedy.  The  poison  is  an 
acid.  Lime  water  with  a  couple  of  drops  of  carbolic  acid  to  the 
ounce  is  also  good.  Menthol  and  talcum  powder  give  some 
relief. 

17.  Chilblains 

This  common  condition  is  caused  by  chilling  of  some  part  of 
the  body  and  is  most  frequently  seen  in  old  people  with  poor 
circulation.  The  most  common  places  for  chilblains  are  the  heel, 
toes,  ears,  nose  and  ringers. 

In  sensitive  people,  as  it  is  due  to  cold,  it  may  be  prevented 
by  warm  clothing  and  frequent  bathing  of  the  part  of  the  body 
affected  in  warm  water,  afterward  drying  it  with  soft  towels. 

Symptoms. — They  are  the  well-known  red  appearance  of  the 
skin,  which  appears  when  the  part  is  brought  near  the  heat, 
especially  in  winter  after  being  in  the  cold.  There  is  consider- 
able burning  and  itching. 

Treatment. — Paint  every  two  or  three  days  with  tincture  of 
iodine  pure  or  diluted  with  alcohol.  Several  coats  of  collodion 
at  intervals  of  a  few  days  are  also  good,  as  the  collodion  exerts 
considerable  pressure  on  the  dilated  blood-vessels.  If  these 
measures  fail,  it  is  best  to  consult  a  physician,  as  chilblains  are 
sometimes  very  difficult  to  cure. 

18.  Corns 

Corns  are  of  two  kinds — hard  and  soft.  The  former  occur  at 
the  sides  of  the  toes  and  at  the  sides  and  bottoms  of  the  feet.  Soft 
corns  form  between  the  toes  where  the  natural  secretion  makes 
the  skin  soft  and  pulpy.  Both  varieties  of  corns  may  be  pre- 
vented by  the  most  scrupulous  cleanliness  of  the  feet  and  stock- 
ings and  by  wearing  well-fitting  shoes  which  do  not  rub  and  so 
cause  irritation  of  the  skin  which  leads  to  the  formation  of  a 
corn. 

If  a  callus  begins  to  form,  rub  the  place  gently  with  vaseline 
night  and  morning.  Nitrate  of  silver  stick  will  usually  cause 
corns  to  disappear.  An  excellent  corn  remedy  is  one  part  of 
salicylic  acid  to  three  parts  of  simple  cerate.     Bathe  and  soak 


128  COMMON  EMERGENCIES 

the  foot  in  hot  water  for  twenty  minutes,  dry  and  apply  oint- 
ment; cover  corn  with  cotton. 

Hard  corns  should  never  be  cut,  but  should  be  rubbed  down 
smooth  with  sandpaper  after  washing  the  skin.  They  should 
then  be  covered  with  a  corn  plaster  or  a  piece  of  adhesive  plaster. 
Cutting  a  corn,  if  you  get  below  the  hard  skin  of  the  corn,  is 
likely  to  prove  dangerous,  as  it  often  results  in  blood-poisoning. 

Soft  corns  should  be  treated  by  careful  washing  and  drying  of 
the  foot,  especially  between  the  toes,  then  dusting  in  a  little  tal- 
cum powder  and  keeping  the  toes  separated  by  a  small  piece  of 
gauze.  A  corn  which  has  become  inflamed  requires  treatment 
from  a  doctor  on  account  of  the  danger  of  blood-poisoning. 

19.  Plant  Poisons,  Especially  Mushrooms. 

A  number  of  the  common  plants  are  poisonous.  Among  them 
are  Bitter  Sweet,  Deadly  Night  Shade,  Mountain  Ash,  Hemlock 
Hellebore,  Jamestown  Weed,  Wild  Parsley  and  Lettuce  and  cer- 
tain Mushrooms  and  Toadstools.  Cases  of  poisoning,  except 
from  the  last,  are  rare. 

A  rule  which  should  always  be  observed  is  never  to  eat  anything 
growing  unless  you  are  very  sure  that  you  know  that  it  is  not 
poisonous,  and  to  prevent  children  from  doing  so. 

Mushroom,  sometimes  called  toadstool  poisoning,  is  com- 
monly due  to  failure  to  tell  the  poisonous  from  the  non-poisonous 
varieties. 

The  rules  which  are  commonly  accepted  for  doing  so  are  as 
follows: 

Consider  dangerous  all  mushrooms  which  have: 

1.  "A  cup-like  formation  at  the  base  of  stem  (so-called 
death  cup)." 

2.  "A  scaly  or  close-fitting  layer  at  the  base  of  the  stem." 

3.  "Loose  warts  on  the  cap." 

4.  "A  milky  juice  (unless  this  is  red)." 

5.  "Great  brittleness,  with  gills  nearly  all  of  equal  length 
and  the  flesh  of  the  cap  thin." 

6.  "A  honeycombed  appearance  of  the  gills,  if  the  flesh 


HOME   MEDICINES  120. 

tastes  bitter,  or  the  mouths  of  the  tubes  are  reddish,  or 
the  flesh  changes  color  when  cut  or  bruised." 

7.  "A  cobwebby  veil  or  ring  when  the  plant  is  young." 

8.  "A  slimy  cap  and  clay-colored  spores"  (Dulles). 
Moreover,  all  mushrooms  that  are  decaying  or  are  in  the 

immature  button  stage  should  be  discarded. 

Symptoms  of  Poisoning  from  Growing  Plants. — Nausea  and 
vomiting.  Severe  pain  in  abdomen.  Great  depression.  Un- 
consciousness, sometimes  weak  pulse,  shallow  respiration.  De- 
lirium from  some  poisons. 

Treatment. — Send  for  doctor.  Cause  vomiting.  Stimulants. 
Rest  in  lying-down  position,  with  head  low. 

20.  Home  Medicines 

While  the  first  aider  is  supposed  to  make  all  possible  use  of 
material  which  she  finds  at  hand  anywhere  there  are  certain 
articles  which  cannot  be  improvised.  Especially  in  the  home, 
perhaps,  and  even  in  a  city  with  drug  stores  nearby  it  is  wise  to 
have  a  small  supply  of  a  few  simple  remedies  and  of  surgical 
dressings.  This  is  particularly  the  case  with  children  in  the 
household,  as  little  people  are  so  likely  to  hurt  themselves  and  are 
much  more  liable  to  sudden  illness  than  their  elders. 

Numbers  of  medicine  cabinets  are  on  the  markets  but  in  few, 
unfortunately,  have  the  contents  been  selected  with  practical 
knowledge  of  the  needs  and  limitations  of  the  first  aider.  Some 
contain  drugs  which  should  never  be  prescribed  except  by  a 
physician.  This  objection  does  not  apply  to  the  Red  Cross 
Home  Cabinet  which  has  only  the  simple,  safe  remedies  that  are 
recommended  in  this  book.  There  is  no  good  reason,  however, 
why  anyone  should  not  purchase  her  own  supplies  and  make  up 
her  own  cabinet.  It  is  believed  that  all  medical  supplies  should 
be  put  in  some  sort  of  a  box  as  otherwise  they  will  be  lost  and 
wasted  and  what  is  even  more  important  cannot  be  found  in 
time  of  need.  Hanging  cabinets  are  more  convenient  as  by  open- 
ing the  door  all  the  contents  may  be  seen  at  a  glance.  They  are, 
however,  more  difficult  to  make  as  cross  partitions  must  be  put 
in.  It  may,  therefore,  be  better  in  some  cases  to  use  a  box  in 
9 


I30  COMMON  EMERGENCIES 

which  the  contents  may  be  placed  on  the  bottom  with  a  view  to 
putting  it  on  a  convenient  shelf.  Either  a  wooden  or  tin  box 
may  be  used  for  the  latter  but  if  a  hanging  cabinet  is  to  be  made  a 
wooden  box  will  be  found  more  suitable  on  account  of  the  parti- 
tions. In  any  case  the  box  had  best  be  painted  inside  and  out 
with  white  enamel  paint.  It  is  also  better  to  provide  a  lock  and 
key. 

Do  not  make  your  medicine  box  too  small,  it  is  well  to  leave 
space  for  medicines  prescribed  by  a  doctor  in  illness  so  that  they 
may  be  put  away  in  a  safe  place.  This  does  not  mean,  however, 
that  medicines  which  have  served  their  purpose  should  be  kept. 
The  sooner  they  are  gotten  rid  of  the  better. 

It  is  best  to  select  a  standard  size  of  bottle.  The  two-ounce 
square  bottle  will  generally  be  found  most  convenient.  The 
few  drugs  which  will  be  required  in  larger  quantities  may  be  put 
in  two  bottles. 

The  supplies  suggested  for  the  household  medicine  box  are  as 
follows: 

Alcohol,  4  ounces. 

Aromatic  spirits  of  ammonia,  2  ounces  (rubber  cork). 

Aqua  ammonia — hartshorn — 2  ounces,  labeled  "poison 
very  irritating"  (rubber  cork).     • 

Castor  oil,  4  ounces. 

Epsom  salts,  4  ounces  (or  half  dozen  Seidlitz  powders). 

Lime-water,  2  ounces. 

Mustard,  powdered,  2  ounces. 

Syrup  of  ginger,  2  ounces. 

Syrup  of  ipecac,  2  ounces. 

Witch-hazel,  4  ounces. 

Calomel  tablets,  one-tenth  grain;  small  bottle  (50-100 
tablets). 

Bismuth    subnitrate    tablets,    5    grain    (100    tablets    in 
bottle). 

Carbolized  vaselin  or  petrolatum,  1  tube. 

Oil  of  cloves,  1  dram  bottle  (labeled  "poison"). 

Soda  mint  tablets,  100  tablets  in  bottle. 

Talcum  powder,  1  tin. 


QUESTIONS  131 

Antiseptic  gauze,  1  small  package. 

Absorbent  cotton,  \  pound. 

Roller  bandages,  gauze,  6,  3  large  and  3  small. 

First-aid  outfits,  Red  Cross,  2. 

Collodion;  1  small  bottle  with  brush. 

Tooth  plasters,  1  box. 

Corn  plasters,  1  box. 

Glass  and  spoon,  1  each  or  medicine  glass,  1. 

Scissors,  1  pair. 

Pins,  ordinary  and  safety. 

QUESTIONS 

1.  What  are  the  dangers  of  self-medication? 

2.  What  are  the  dangers  of  patent  medicines? 

3.  What  are  the  commonest  causes  of  colic? 

4.  How  would  you  treat  colic? 

5.  How  would  you  treat  diarrhea;  constipation? 

6.  Treatment  of  nausea  and  vomiting? 

7.  Treatment  of  hiccough? 

8.  How  would  you  treat  chill  from  exposure  to  cold? 

9.  How  would  you  know  that  a  child  had  croup  and  how  would 
you  treat  it? 

10.  How  would  you  treat  neuralgia  of  the  face? 

11.  Treatment  of  tooth-ache? 

12.  Treatment  of  ear-ache? 

13.  How  would  you  treat  a  stye? 

14.  How  would  you  prevent  and  treat  sunburn? 

15.  Treatment  and  prevention  of  prickly  heat? 

16.  How  would  you  recognize  poison  ivy  and  poison  oak? 

17.  Treatment  for  ivy  poisoning? 

18.  Treatment  of  mosquito  bites? 

19.  What  are  chilblains  due  to  and  how  would  you  prevent  and  treat 
them? 

20.  Prevention  and  treatment  of  corns? 

21.  What  are  the  common  poisonous  plants? 

22.  Treatment  of  mushroom  poisoning? 

PRACTICAL  EXERCISES 

General  review. 


CHAPTER  X 

CARRYING  AND  HOME  PREPARATIONS  FOR  SICK  AND 
INJURED 

i.  Carrying.  2.  Lifting  into  Bed.  3.  Selection  and  Prep- 
aration of  Room.  4.  Selection  and  Preparation  of 
Bed.  5.  Removal  of  Clothing.  6.  Position  in  Bed. 
7.  Preparations  for  Doctor. 

Of  course  the  object  of  the  first  aider  is  not  only  to  give  the 
necessary  immediate  treatment  but  to  get  sick  and  injured  into 
the  hands  of  a  doctor  in  the  best  possible  condition  or,  in  case  the 
services  of  a  doctor  are  not  needed,  to  their  homes  or  to  some 
other  safe  place.  One  of  the  most  important  things  to  be  con- 
sidered and  determined  also  is  whether  or  not  a  doctor  is  required. 
This  question  has,  however,  been  discussed  at  length  in  connec- 
tion with  different  injuries  and  will  not  again  be  referred  to 
here. 

It  is  clear  that  if  one  does  not  know  what  to  do  for  a  patient 
after  his  or  her  injury  has  been  cared  for  the  good  from  the  best 
first-aid  treatment  may  be  largely  or  wholly  undone. 

1.  Carrying 

It  will  only  be  very  rarely  that  it  will  be  found  necessary  for 
women  actually  to  carry  patients.  Still  they  should  know  how 
patients  should  be  carried  in  order  that  they  may  direct  the 
bearers. 

Whatever  method  of  transportation  is  adopted,  first  aid  should 
be  given  before  it  is  attempted  and  when  necessary  the  clothing 
should  be  loosened  so  that  it  will  not  constrict  the  neck,  chest 
or  abdomen   during   transportation.     Clothing   should  not  be 

132 


CARRYING  133 

removed,  however,  as  this  will  increase  shock  and  as  patients 
almost  always  feel  chilly  as  the  result  of  shock  they  should, 
when  possible,  be  covered  with  a  blanket  or  rug. 

All  serious  cases  of  illness  or  injury  should  be  carried  on 
stretchers  when  it  is  possible  to  procure  or  to  make  them  and 
when  in  doubt  as  to  the  severity  of  an  illness  or  injury  it  is  always 
much  safer  to  so  carry  a  patient.  The  ordinary  stretcher  is 
so  well  known  that  it  is  hardly  necessary  to  describe  it.  This 
stretcher  has  two  long  poles  with  a  bed,  usually  of  canvas, 
between  them  and  cross-pieces  to  keep  the  long  poles  apart  and 
thus  to  stretch  the  canvas.  The  poles  are  long  enough  to  give  the 
bearers  handholds  at  each  end  of  the  stretcher.  Fairly  satisfac- 
tory stretchers  may  be  made  from  materials  which  are  usually 
easily  procured.  One  of  the  easiest  to  make  is  the  coat  stretcher. 
For  this  two  coats  and  a  pair  of  poles  are  required.  The  sleeves 
of  the  coats  are  first  turned  inside  out  and  the  coats  are  then 
placed  on  the  ground  with  their  lower  edges  touching  each  other. 
The  poles  are  passed  through  the  sleeves  on  each  side,  and  the 
coats  are  buttoned  and  the  buttoned  side  turned  down.  Two 
poles  and  a  large  blanket,  rug  or  strong  sheet  may  also  be  used 
to  make  a  stretcher.  The  blanket,  rug  or  sheet  is  spread  on  the 
ground  and  the  poles  are  placed  on  the  edges  of  the  long  sides. 
These  edges  are  then  rolled  on  the  poles  until  a  distance  of  about 
20  inches,  that  necessary  for  the  shoulders  of  the  patient,  is  left 
between  them.  This  stretcher  may  be  turned  over  before 
being  used  and  especially  with  narrow  blankets,  rugs  or  sheets 
it  is  much  safer  to  bind  them  to  the  poles  with  twine.  With 
both  these  stretchers,  except  when  it  is  only  necessary  to  go  a 
short  distance  it  is  desirable  to  tie  on  two  pieces  of  wood  for 
cross-pieces  so  as  to  prevent  the  poles  from  being  forced  together 
when  the  weight  of  the  patient  is  put  on  the  stretcher.  Bags  and 
sacks  may  also  be  used  for  stretcher  beds.  The  bottoms  should 
be  torn  so  that  the  poles  may  be  passed  through  a  number  suffi- 
cient to  give  the  length  of  stretcher  bed  required.  These  and 
similar  stretchers  should  always  be  tested  by  lifting  an  uninjured 
man  before  they  are  used  for  the  patient.  Great  care  is  also 
necessary  to  guard  against  accidents  during  transportation. 


134     CARRYING  AND  HOME  PREPARATIONS  FOR  SICK  AND  INJURED 

Numbers  of  other  articles  may  be  used  for  stretchers  in  case  of 
necessity.  Such  articles  are  doors,  window  shutters,  boards, 
bed-frames,  benches,  ladders,  mattresses,  blankets,  rugs,  sheets, 
and  mats.  It  should  be  remembered,  however,  that  these  have 
a  disadvantage  over  those  which  have  been  described  above. 
The  former,  with  care,  require  but  two  bearers,  while  for  the 
latter  four  must  always  be  employed.  Four  bearers,  especially 
if  they  are  untrained,  can  never  work  together  as  well  as  two,  so 
with  four  bearers  the  patient  will  be  jolted  more  with  an  increase 
of  suffering  and  possibly  further  injury. 

Whatever  the  kind  of  stretcher  used,  the  greatest  gentleness 
should  be  employed  in  putting  the  patient  on  it,  in  carrying,  and 
in  removing  the  patient  when  he  has  reached  his  destination. 
To  effect  this  the  bearers  must  work  together  in  all  these 
movements. 

Four  bearers  are  required.  For  them  select  strong,  sturdy 
men  of  about  equal  height.  They  should  be  intelligent  in  order 
that  they  may  understand  your  directions.  Don't  be  afraid 
of  spending  a  little  time  in  explaining  just  what  you  want  done, 
you  will  save  in  the  end.  First  have  one  of  the  bearers  bring 
the  stretcher  close  to  the  patient  but  not  so  near  that  it  will 
interfere  with  lifting  him.  The  most  convenient  place  for  the 
stretcher  will  be  about  2  feet  from  the  patient's  head  in  line 
with  his  body.  Then  have  three  bearers  take  position  on  one 
side  of  the  patient  and  one  on  the  other  side.  If  the  patient  is 
not  on  his  back  the  single  bearer  should  be  directed  to  put  him 
in  that  position.  Of  course,  it  is  understood  that  first-aid 
treatment  has  already  been  given.  The  proper  places  for  the 
bearers  are,  the  single  bearer  opposite  the  patient's  hips,  one 
of  those  on  the  other  side  also  at  the  hips  between  the  other  two, 
one  at  the  shoulder  and  one  at  the  knees.  At  this  time  it  will 
be  well  to  explain  no  movements  are  ever  to  be  made  until  you 
give  the  word.  Now,  have  all  four  bearers  facing  the  patient 
kneel  on  the  knees  nearest  the  patient's  feet.  Have  the  single 
bearer  and  the  man  opposite  him  pass  their  arms  under  the 
patient's  back  and  thighs,  the  man  at  the  shoulder  puts  one  arm 
under  the  patient's  shoulders  and  the  other  under  his  neck  to  the 


CARRYING 


135 


Z  Making  Coat  Stretcher  by  Stretching  Coat 
over  Head  onto  two  Poles 


4.  Loading  Patient*  on  Stretcher 

(Note  all  bearen  kneel  on  knee         — * 
nearest  injured  man'i  feet)  -■«-£ 


5.  Carrying  Patient  on  Stretcher 


Plate  XVIII.— Transportation. 


136     CARRYING  AND  HOME  PREPARATIONS  EOR  SICK  AND  INJURED 

further  shoulder  so  as  to  support  the  head,  at  the  same  time  the 
man  at  the  knees  places  both  arms  under  the  legs.  Ask  the  bear- 
ers if  they  are  ready  and  then  say  "Lift.''  Then  the  bearers 
must  all  lift  together  and  place  the  patient  on  the  knees  of  the 
three  bearers  who  are  in  line.  These,  of  course,  form  a  firm 
bench.  As  soon  as  the  patient  is  safely  in  position,  the  single 
bearer  should  be  told  to  leave  him  and  to  get  the  stretcher  and 
■put  it  under  him  against  the  other  bearers'  ankles.  The  single 
bearer  should  then  put  his  arms  under  the  patient's  back  and 
thighs  as  before.  Ask  again  if  the  bearers  are  ready  and  give 
the  word  "Lower."  The  patient  is  then  gently  lowered  to  the 
stretcher. 

Next,  have  one  bearer  take  position  between  the  stretcher 
handles  at  the  front  and  another  at  the  rear.  Direct  them  to 
stoop  and  to  take  hold  of  the  handles  but  not  to  lift  until  you  give 
the  word  "Lift."  Then  they  rise  and  stand  erect.  They  should 
not  move  forward,  however,  till  the  word  "March"  is  given. 
Then  the  one  at  the  front  steps  off  with  his  left  foot  and  the 
bearer  at  the  rear  with  his  right  foot  so  as  to  break  step.  This 
will  jolt  the  stretcher  much  less  than  though  the  bearers  are  in 
step  and  if  they  take  short  steps  instead  of  long  ones  this  will 
help  in  the  same  way.  Always  carry  the  patient  feet  first  except 
when  going  up  a  hill  or  upstairs  when  he  should  be  carried  head 
first,  the  stretcher  being  kept  as  level  as  possible.  The  two 
bearers  who  are  not  carrying  the  stretcher  march  at  its  sides  to 
give  any  needed  assistance  and,  of  course,  finally  to  help  remove 
the  patient.  The  motions  are  reversed  in  removing  a  patient 
from  a  stretcher. 

When  four  bearers  must  be  employed  everything  is  done  in 
the  same  way  except  that  four  instead  of  two  men  carry  the 
stretcher. 

Generally  speaking,  the  bearers  should  take  the  shortest  course 
in  carrying  the  patient  to  his  destination,  but  it  is  much  better 
to  go  around  all  obstacles  than  over  them  as  this  will  jolt,  the 
patient  less. 

Explain  to  the  bearers  further  that  you  will  tell  them  where  you 
wish  them  to  stop;  but  after  doing  this  they  are  not  to  lower  the 


LIFTING  INTO  BED  137 

stretcher  until  you  give  the  word  "Lower."  Then  the  stretcher 
should  be  gently  lowered  to  the  ground. 

As  explained  above,  in  carrying  a  patient  upstairs  or  uphill 
he  should  go  head  and  not  feet  first.  To  do  this  without  con- 
fusion it  will  be  best  to  stop  the  stretcher  at  the  foot  of  the  hill 
or  of  the  stairs,  as  the  case  may  be,  and  to  lower  it  to  the  ground. 
Then  have  the  bearers  face  in  the  opposite  direction,  lift  the 
stretcher,  turn  it  around  slowly  and  then  go  up  the  hill  or  stairs. 

Of  course,  the  position  of  the  patient  on  the  stretcher  should 
be  such  that  his  particular  injury  will  receive  no  further  hurt. 
Usually  it  will  be  best  to  make  a  pillow  from  a  folded  coat  but 
if  the  patient  is  very  faint  or  has  lost  a  great  deal  of  blood  he  is 
safer  without  the  pillow. 

A  convenient  method  of  carrying  a  patient  without  a  stretcher 
is  to  seat  her,  and  this  is  particularly  well  adapted  for  women,  in 
a  strong  chair  and  have  two  bearers  lift  the  chair,  one  at  the  front 
and  the  other  at  the  rear.  The  chair  should  be  inclined  back- 
ward so  that  the  patient  is  almost  in  the  lying-down  position. 

A  patient  able  to  sit  up  and  steady  himself  by  placing  his  arms 
around  the  bearers'  necks  may  be  carried  in  the  "Lady's  Chair. " 
To  form  this  each  bearer  should  grasp  his  left  wrist  in  his  right 
hand  and  the  other  bearer's  right  wrist  in  his  left  hand  with  the 
knuckles  uppermost.  The  bearers  then  stoop  and  place  the 
" chair"  under  the  sitting  patient  who  steadies  himself  by  placing 
his  arms  around  their  necks. 

2.  Lifting  into  Bed 

It  is  somewhat  easier  to  do  this  with  a  narrow  bed  as  with  this 
bearers  can  work  on  both  sides  in  lifting,  carrying,  and  lowering 
the  patient.  With  a  narrow  bed  have  the  loaded  stretcher, 
patient  carried  head  first,  brought  to  the  foot  of  the  bed  and  in 
line  with  it.  Then  have  the  bearers  raise  the  patient  on  their 
knees  just  as  though  they  were  going  to  lower  him  to  the  ground. 
After  the  single  bearer  has  removed  the  stretcher  he  will,  of 
course,  return  to  assist  with  the  patient.  When  his  arms  are  in 
position  to  do  this,  the  word  "Rise"  should  be  given,  then  the 


138     CARRYING  AND  HOME  PREPARATIONS  FOR  SICK  AND  INJURED 

bearers  all  supporting  the  patient  will  rise  to  their  feet  and  carry 
the  patient  to  the  bed,  side  stepping  on  each  side,  thus  passing 
the  patient  over  the  foot-board.  When  in  proper  position  the 
patient  should  be  gently  lowered  to  the  bed  and  the  bearers 
remove  their  arms. 

If  the  bed  is  too  wide  for  this  method  to  be  adopted  or  if  there 
is  no  space  to  place  the  stretcher  in  line  with  the  bed  at  its  foot 
a  slightly  different  plan  must  be  followed.  For  this  the  loaded 
stretcher  is  placed  at  the  side  of  the  bed  and  the  patient  is  raised 
in  exactly  the  same  way,  the  stretcher,  of  course,  being  taken  out 
of  the  way.  After  the  single  bearer  has  assisted  in  raising  the 
patient,  however,  he  steps  to  one  side  and  the  other  three  bearers 
carry  the  patient  forward  over  the  side  of  the  bed. 

3.  Selection  and  Preparation  of  Room 

Generally  speaking  the  patient's  own  room  is  best.  This  is 
because  he  will  usually  be  better  contented  there  and  will  not 
worry  himself  by  desiring  a  change,  a  matter  of  some  importance 
in  serious  disease  or  illness.  In  severe  injury,  however,  it  may 
not  be  possible  to  take  a  person  to  his  own  room  on  account  of 
the  difficulties  presented  by  narrow  passage-ways  or  steep  stairs. 
The  room  selected  must,  of  course,  be  free  from  these  objections 
but,  if  possible,  it  should  not  be  a  ground-floor  room,  as  such  rooms 
are  likely  to  prove  noisy  and  do  not  afford  the  privacy  desir- 
able for  persons  in  serious  condition.  In  illness,  if  the  patient's 
own  room  is  unsuitable  for  some  good  reason,  it  is  best  to  choose 
a  room  as  far  separated  as  practicable  from  other  members  of 
the  family.  This  is  particularly  the  case  in  contagious  diseases 
when  the  well  should  never  be  endangered  by  the  sick  if  it  can 
possibly  be  prevented.  A  room  on  the  upper  floor  is  better  for 
such  cases  for  two  reasons.  Well  people  are  less  likely  to  enter 
it  and  all  the  currents  of  air  in  a  house  are  upward.  A  toilet 
nearby  will  save  many  steps  in  serious  illness  or  injury  and  will 
also  be  safer  in  cases  of  contagious  disease. 

If  the  patient  must  be  carried  to  his  sick  room  on  a  stretcher, 
the  way  to  it  should  be  cleared  previously  by  removing  furni- 
ture and  loose  rugs  over  which  the  bearers  might  trip. 


SELECTION  AND  PREPARATION  OF  BED  139 

All  useless  articles  should  be  removed  from  the  sick  room. 
These  include  furniture,  clothing  and  hangings,  also  most  if  not 
all  of  the  pictures  from  the  walls.  Judgment  must  be  shown  in 
doing  this,  however.  Persons  not  seriously  ill  or  injured  will 
enjoy  having  their  belongings  about  them.  This  is  not  the  case 
if  the  condition  of  the  patient  is  serious  and  everything  useless 
makes  more  work.  Moreover,  the  delirious  brain  is  likely  to 
twist  almost  everything  into  some  horrible  shape.  The  furni- 
ture of  the  room  in  contagious  disease  should  consist  of  the  bed, 
a  small  plain  table,  two  chairs  without  upholstery  and  the 
window  shades.  In  preparing  the  sick  room  be  particularly 
careful  not  to  stir  up  the  dust. 

The  room  should  not  be  dark  but  the  shades  should  be  so  ar- 
ranged as  to  exclude  the  glare  of  the  sun. 

4.  Selection  and  Preparation  of  Bed 

A  narrow,  high  bed  is  to  be  preferred  and  should  always  be 
used  if  available.  In  the  first  place  it  is  easier  to  lift  a  patient 
into  a  narrow  bed  and  in  the  second  he  is  much  more  easy  to 
care  for  in  such  a  bed.  If  it  is  high  in  addition  much  stooping 
over  is  saved.  The  bed  should  be  drawn  out  from  the  wall  so 
that  it  may  be  easily  reached  from  all  sides. 

A  firm  mattress  is  much  the  best.  Two  fairly  hard  pillows 
should  also  be  provided.  The  lower  sheet  should  be  smooth 
and  it  had  best  be  kept  so  by  safety  pins  at  the  sides  of  the 
mattress.  Over  this  in  serious  illness  or  injury  a  draw  sheet 
should  be  placed.  This  is  an  ordinary  sheet  so  folded  length- 
wise that  it  will  extend  from  the  middle  of  the  patient's  back  to 
his  knees.  It  should  be  pinned  in  place  like  the  lower  sheet. 
While  it  may  be  necessary  to  put  a  piece  of  rubber  sheeting  under 
the  draw  sheet  in  order  to  protect  the  bed  do  not  use  this  unless 
it  is  really  needed  as  it  is  likely  to  prove  hot  and  uncomfortable. 
The  top  covering  should  consist  of  a  sheet  and  ordinarily  of  a 
double  blanket.  The  upper  covering  should  be  turned  well 
back.  Extra  sheets  and  blankets  should  be  ready  at  hand.  It 
is  well  to  have  hot-water  bottles  and  hot  blankets  ready,  espe- 


140     CARRYING  AND  HOME  PREPARATIONS  FOR  SICK  AND  INJURED 

dally  for  injured  for  there  is  likely  to  be  a  great  deal  of  shock. 
If  they  are  used  to  heat  the  bed  the  covers  must,  of  course,  not 
be  turned  back  till  immediately  before  the  patient  is  put  in  bed. 

Special  preparations  are  often  necessary  for  fractures  of  the 
thigh  and  leg.  Two  or  three  boards  are  sometimes  put  under 
the  mattress  to  prevent  bending  of  the  bone  at  the  place  it  is 
broken.  Bed  cradles,  as  they  are  called,  are  also  used  to  support 
the  weight  of  the  bed  clothes.  A  band-box  with  a  hole  cut 
through  for  the  leg  or  a  stool  are  sometimes  used  for  this  purpose 
or  a  piece  of  twine  may  be  run  through  the  bed  covers  and  tied 
to  the  foot  of  the  bed  or  to  a  nail  in  the  wall. 

When  there  has  been  a  great  deal  of  blood  lost  it  may  be  neces- 
sary to  raise  the  foot  of  the  bed.  A  couple  of  soap  boxes  will 
answer  well  for  this. 

5.  Removal  of  Clothing 

Something  has  already  been  said  on  this  subject  but  it  will 
perhaps  be  better  to  repeat  this  in  part  here.  The  principle 
which  should  govern  our  actions  in  this  respect  is  to  think  first 
of  the  patient  and  second  of  his  clothes.  In  serious  cases  clothes 
should  be  cut  freely  rather  than  to  run  risk  of  further  injury  by 
trying  to  take  them  off.  In  ripping  up  a  seam  in  clothing  always 
take  the  seam  which  can  be  most  easily  reached.  For  example, 
with  the  trousers  the  outside  seam  should  be  ripped.  In  undress- 
ing always  draw  out  the  uninjured  limb  first,  but  in  dressing, 
dress  the  injured  limb  first. 

In  burns  probably,  most  damage  may  be  done  if  care  is  not 
taken  in  respect  to  the  clothing.  Never  drag  the  clothing  off 
a  burn  or  scald.  Cut  off  all  you  can  with  a  sharp  pair  of  scissors 
and  soak  what  remains  with  oil.  Of  course,  the  attention  of 
the  doctor  should  be  called  to  this  as  soon  as  he  arrives. 

In  injuries,  the  clothing  is  likely  to  be  very  dirty  and  it  should 
be  removed  before  the  patient  is  put  into  the  clean  bed.  For 
this  purpose  he  may  be  placed  for  the  time  being  on  another  bed, 
a  lounge  or  a  table.  To  prevent  soiling  them  they  should  be 
covered  with  newspapers  and  old  sheets,  or  several  thicknesses 


PREPARATION   FOR  DOCTOR  141 

of  newspapers  alone  do  very  well.  If  it  is  absolutely  necessary 
to  use  the  patient's  bed  it  should  be  protected  from  dirt  in  the 
same  way. 

6.  Position  in  Bed 

This  is  governed,  of  course,  by  the  same  general  principles 
which  have  been  noted  elsewhere.  That  is  to  say,  if  the  patient 
is  pale  or  feels  faint  or  has  lost  much  blood  do  not  give  him  a 
pillow  but  make  him  lie  flat.  It  is  in  such  cases  that  the  foot 
of  the  bed  should  be  raised. 

When  the  patient's  face  is  red  raise  his  head  on  a  pillow* 

7.  Preparations  for  Doctor 

The  first  thing  to  make  sure  of  is  that  the  doctor  will  come 
with  sufficient  knowledge  of  the  condition  of  the  patient  to  bring 
whatever  may  be  necessary  and  thus  to  save  valuable  time. 
In  this  connection  we  are,  of  course,  considering  injuries  espe- 
cially and  not  diseases.  Communication  with  the  doctor  by  tele- 
phone is  best  as  this  will  enable  him  to  make  necessary  inquiries, 
If  this  is  not  practicable  send  a  written  message.  However  you 
communicate  with  the  doctor  try  to  be  as  clear  in  your  statements 
as  possible. 

Very  probably  if  you  talk  to  the  doctor  over  the  telephone  he 
will  tell  exactly  what  preparations  he  wants  made.  Then  all 
responsibility  is  off  your  shoulders  if  you  carry  out  his  directions 
to  the  letter  and  this  should,  of  course,  always  be  done.  Sup- 
pose, however,  preparations  are  left  to  your  own  good  judgment. 
Remember,  first,  that  there  will  probably  have  to  be  an  examina- 
tion of  the  patient  so  the  room  should  be  warm  in  order  not  to 
increase  shock  from  chilling  of  his  body.  If  there  is  a  serious 
wound  for  which  you  think  some  kind  of  an  operation  will  have 
to  be  performed  it  will  save  a  great  deal  of  time  if  you  will  get 
a  room  ready  for  this.  In  the  first  place  you  want  a  good  light, 
a  north  light  if  possible.  Then  you  will  require  a  table.  An 
ordinary  kitchen  table  well  scrubbed  with  soap  and  water  will 


142     CARRYING  AND  HOME  PREPARATIONS  FOR  SICK  AND  INJURED 

do  very  well.  Another  small  table  will  be  needed  for  dressings, 
etc.  It  is  better  not  to  try  to  clean  the  room  you  have  selected 
for  an  operating  room  as  this  will  stir  up  the  dust.  On  the  con- 
trary leave  it  strictly  alone  and  do  not  allow  people  to  enter  it 
for  this  will  raise  the  dust.  If  the  doctor  wants  anything  special 
done  to  the  room  his  wishes  may  be  carried  out  while  he  is  pre- 
paring for  the  operation. 

When  an  operation  will  probably  be  required  you  will  need 
plenty  of  hot  and  cold  water  and  the  greater  part  of  this  should 
have  been  boiled  for  ten  minutes  so  you  must  start  boiling  water 
as  soon  as  possible.  Do  not  remove  that  which  has  been  boiled 
from  the  vessels  containing  it  but  put  aside  the  greater  part  of 
it  to  cool  in  them  as  soon  as  it  has  boiled  ten  minutes.  You 
will  also  need  several  basins.  After  making  them  perfectly 
clean  they  should  be  rinsed  out  with  boiling  water  and  not  wiped 
but  put  aside  for  use  just  as  they  are.  At  least  a  dozen  clean 
towels,  and  soap  should  also  be  provided.  A  pail  or  slop  bucket 
will  answer  well  enough  for  the  waste  water. 

The  preparations  for  a  large  dressing  are  about  the  same  as  for 
an  operation.  When  smaller  wounds  required  dressing  this 
may  often  be  done  in  the  patient's  bed.  The  preparations  in 
other  respects  should  be  the  same  and  some  kind  of  waterproof 
cloth  should  be  provided  to  protect  the  bed.  Except  in  the  cases 
mentioned  it  will  hardly  be  worth  while  to  make  special  prepara- 
tions for  the  doctor's  first  visit  unless  he  directs  that  this  be  done. 
For  later  visits  you  will  learn  from  him  just  what  will  be  required. 

QUESTIONS 

i.  Show  what  you  would  do  and  say  if  you  were  called  upon  to 
direct  four  men  to  carry  an  injured  person  on  a  stretcher. 

2.  How  would  you  have  an  injured  person  carried  up  stairs? 

3.  How  should  a  person  be  lifted  from  a  stretcher  to  a  bed? 

4.  What  points  would  you  take  into  account  in  selecting  a  sick 
room? 

5.  What  sort  of  a  bed  would  you  choose  and  how  would  you  get 
it  ready  for  a  patient? 

7.  How  would  you  remove  the  clothing  from  a  seriously  injured 
person? 


PRACTICAL   EXERCISES  I43 

8.  In  what  position  should  the  patient  be  put  in  bed? 

10.  What  sort  of  a  message  would  you  send  to  a  doctor  if  an  injured 
person  had  been  brought  to  your  home? 

11.  What  preparations  should  you  make  before  the  arrival  of  the 
doctor? 

PRACTICAL  EXERCISES 

Practice  in  carrying  a  patient.  This  may  actually  be  done  if 
you  have  a  light  boy  for  a  subject  but  in  any  event  the  neces- 
sary motions  may  be  satisfactorily  demonstrated.  When  prac- 
tical the  preparation  of  the  bed  and  lifting  the  patient  into  it 
should  also  be  demonstrated. 

The  best  exercise  will  be  to  describe  some  injury  and  to  tell 
the  members  of  the  class  to  do  everything  necessary  till  the 
patient  is  in  bed. 


INDEX 


Abdomen,  23 

bruises,  28 

wounds,  58 
Acids,  burns  from,  85 

in  eye,  85 
Alcohol,  intoxication,  no 

poisoning,  no 
Alkalies,  burns  from,  85 

in  eye,  85 
Ammonia  aromatic  spirits  of,  as 

stimulant,  7 
Antiseptic  tablets,  57 
Apoplexy,  no 
Arm,  fracture,  38 

sling,  20 
Aromatic  spirits  of  ammonia   as 

stimulant,  7 
Arteries,  66 

course,  66 

hemorrhage  from,  66 

points    on    which    to    make 
pressure,  68 
Artificial  respiration,  93 

Back,  broken,  44 
Bandages,  10 

chest,  18 

cravat,  10 

eye,  18 

figure-of-8,  14 

foot,  20 

four-tailed,  14 

hand,  18 

head,  16 

jaw,  18 

neck,  18 

nose,  18 

pelvis,  18 

roller,  5 

shoulder,  18 

spica,  14 

T,  20 

triangular,  10 


Bed,    selection    and   preparation 
of,  139 

Bichloride  of  mercury,  57 

Bites  of  insects  and  spiders,  63 

Bleeders,  72 

Bleeding,  65 

Blood,  71 

coagulation  of,  71 
course  in  arteries,  66 
in  capillaries,  71 
in  veins,  71 
symptoms  from  loss  of,  72 

Blood-vessels,  66 

Body,  the,  22 

Bones,  23 

broken,  34 

Brain,  injuries  of,  no 

Broken  back,  44 

Bruises,  strains,  sprains,  disloca- 
tions and  fractures,  22 

Bullet  wounds,  51 

Burns,  82 
acids,  85 
alkalies,  85 
electric,  86 

Capillaries,  68 

Carbolic  acid  poisoning,  112 

Carrying  patients,  method  for,  132 

Cat  bites,  62 

Chest,  23 

bruises  of,  28 
Chilblains,  127 
Chill  from  exposure,  121 
Circulation  of  blood,  65 
Clothing,  removal  of,  140 
Coagulation  of  blood,  71 
Coat  stretcher,  133 
Cold,  injuries  from,  82 
Colic,  118 
Collapse,  5 
Collar-bone,  23 

fracture  of,  41 


10 


145 


146 


INDEX 


Collodion,  53 

Common  emergencies,  117 

Compound  fractures,  36 

Compresses,  53 

Constipation,  120 

Corns,  127 

Corrosive  sublimate,  57 

Cramp,  118 

Croup,  121 

Cuts,  57 

Diaphragm,  23 
Diarrhea,  119 
Dislocations,  30 

fingers,  32 

jaw,  31 

shoulder,  32 
Doctor,  preparations  for,  141 
Dog  bites,  62 
Dressings,  53 

bandages  for,  20 

for  wounds,  53 
Drowning,  95 
Drunkenness,  no 

Earache,  124 
Electricity,  burns,  86 

shock,  101 
Emergencies,  common,  117 
Emergency  supplies,  home,  129 
Emetics,  113 
Exhaustion,  heat  86 
Eye,  59 

acid  in,  85 

alkali  in,  85 

bandage  of,  18 

foreign  bodies  in,  59 

injury  of,  59 

lime  in,  60 

splinters  in,  60 

Fainting,  108 
Figure-of-8  bandage,  14 
Finger,  dislocation  of,  32 

fracture  of,  39 
Fires,  83 

First  aid,  general  instructions  for 
rendering.  2 

materials,  130 

packets,  54 
Red  Cross,  54 


First  aid,  what  is  it?,  1 

Fits,  109 

Foot,  bandage  of,  20 

crushed,  39 
Forearm  fracture,  38 
Foreign  bodies,  eye,  59 

in  wounds,  58 
Four-tailed  bandage,  14 
Fractures,  34 

arm,  38 

collar-bone,  41 

compound,  36 

fingers,  39 

forearm,  ^8 

jaw,  43 
•   knee-cap,  41 

leg,  40 

nose,  44 

ribs,  43 

simple,  34 

skull,  43 

spine,  44 

thigh,  40 

wrist,  39 
Freezing,  88 
Frost-bite,  88 

Gas,  poisoning,  104 

General  directions  for  rendering 

first  aid,  2 
Germs,  47 
Gunshot  wounds,  51 

Hand  bandage,  18 

crushed,  39 

hemorrhage  from,  75 
Hanging,  106 
Head,  23 

arterial  hemorrhage  from,  75 

bandage,  16 
Heart,  65 

Heat,  exhaustion  from,  86 
Hemorrhage,  65 

arterial,  74 

checking  by  direct  pressure 
in  wound,  77 
by  tourniquet,  76 

from  arm,  75 

from  arm-pit,  75 

from  foot,  75 

from  hand,  75 


INDEX 


147 


Hemorrhage  from  head,  75 

from  leg,  75 

from  neck,  75 

from  scalp,  75 

from  shoulder,  75 

from  thigh,  75 

internal,  79 

lungs,  79 

nose,  80 

stomach,  79 

varicose  veins,  79 

venous,  78 
Hiccough,  120 
Home  emergency  supplies,  129 

medicines,  129 

preparations    for    sick    and 
injured,  132 

Incised  wounds,  51 
Infected  wounds,  50 
Infection,  pus,  50 
Inflammation,  50 
Injured,  transportation  of,  132 
Injuries,  brain,  no 

eye,  59 

feet,  39 

from  cold,  82 

from  electricity,  86,  101 

from  heat,  82 

in    which    the    skin    is    not 
pierced  or  broken,  22 

in  which  the  skin  is  pierced 
or  broken,  47 
Insect  bite,  63 
Insensibility,  107 
Internal  hemorrhage,  79 
Intoxication,  alcoholic,  no 

Jaw,  bandage,  18 

dislocation,  31 

fracture,  43 
Joints,  25 

dislocations  of,  30 

Knee-cap,  fracture,  41 


Leg,  arterial  hemorrhage  from,  75 

fracture,  40 
Lifting  into  bed,  137 


Limbs,  25 
Lime  in  eye,  60 
Liquor  poisoning,  no 
Lockjaw,  63 
Lungs.  91 

hemorrhage  from,  79 

Materials,  first-aid,  130 
Medicine  cabinet,  130 
Medicines,  home,  130 
Microorganisms,  47 
Morphine  poisoning,  in 
Mosquito  bites,  126 
Muscles,  26 
Mushroom  poisoning,  128 

Nails,  splinters  under,  59 
Nausea,  120 
Neck,  bandage,  18 

hemorrhage  from,  75 

wounds,  79 
Nervous  attacks,  121 
Neuralgia  of  the  face,  122 
Nose,  bleeding  from,  80 

fracture,  44 

Opium  poisoning,  in 

Packets,  first-aid,  54 

Red  Cross,  54 
Patent  medicines,  117 
Pelvis,  23 
Plant  poisons,  128 
Plaster,  53 

Poison,  ivy  or  oak,  125 
Poisons,  112 

alcohol,  no 

carbolic  acid,  112 

gas,  104 

morphine,  m 

opium,  in 

treatment  in  general,  113 
Preparations  for  doctor,  141 
Prickly  heat,  125 
Prone  pressure  method  artificial 

respiration,  93 
Punctured  wound,  51 
Pus,  50 

Red  Cross  outfit,  54 
packet,  54 


148 


INDEX 


Respiration,  92 

artificial,  93 
Respiratory  system,  91 
Ribs,  2$ 

fracture  of,  43 
Roller  bandages,  5 
Room,  selection  and  preparation 
of,  138 

Scalds,  82 
Shock,  5 

electric,  101 
Shoulder,     arterial     hemorrhage 

from,  75 
Simple  fracture,  34 
Skeleton,  23 
Skin,  47 

Skull  fracture,  43 
Slings,  arm,  20 
Snake  bite,  61 
Spica  bandages,  14 
Spider  bite,  63 
Spinal  column,  23 
^  fracture  of,  44 
Splinters  in  eye,  60 
in  skin,  58 
under  nail,  59 
Splints,  36 

bandages  for,  20 
Sprains,  29 
Stimulants,  7 
Stings  and  bites  of  insects  and 

spiders,  63 
Stomach  hemorrhage,  79 
Strains,  28 
Stretchers,  132 
Styes,  124 

Subcutaneous  tissue,  26 
Suffocation,  91 
Sunburn,  124 
Sunstroke,  86 


Sylvester's  method,  artificial  res- 
piration, 94 

T  bandage,  20 

Thigh,  arterial  hemorrhage  from, 

r  75 

fracture.,  40 
Toothache,  123 
Torn  wounds,  51 
Tourniquets,  yy 
Transportation  of  injured,  132 
Triangular  bandage,  10 
Trunk,  23 

Unconsciousness,  107 

Varicose  veins,  79 
Veins,  71 

hemorrhage  from,  78 

varicose,  79 
Vomiting,  120 

how  to  cause,  113 

Wounds,  47 

abdominal,  58 

cut,  51 

dressings  for,  53 

eye,  59 

gunshot,  51 

incised,  51 

infected,  50 

inflamed,  50 

in  which  foreign  bodies  re- 
main, 58 

lacerated,  51 

poisoned,  60 

punctured,  51 

splinters  in,  59 

torn,  51 

treatment  of,  52 
Wrist,  fracture  of,  39 


j  6 

ft 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
1  Los  Angeles 

This  book  is  DUE  on  the  last  date  stamped  helow. 


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